Impact of Covid-19 on Tuberculosis Diagnosis and Treatment Outcomes in Buhera District, 2022

Abstract

Zimbabwe implemented a nationwide lockdown starting the 30th of March 2020 to curb the spread of COVID-19. Early in the pandemic, COVID-19 cases were clustered around towns and later spread to rural areas in relatively low numbers. At that time Buhera district did not record a high number of COVID-19 cases until the second quarter of 2020. Since then, the district experienced severe disruptions in the provision of TB care and service delivery more likely from strict lockdown restrictions than COVID-19 infections. A comparative retrospective study was conducted to analyse the impact of COVID-19 on TB case detection, diagnosis, and treatment outcomes in Buhera district. Quarterly TB aggregate data was extracted from the DHIS2. The study periods were divided into the pre-COVID- 19 period (April 2019 to March 2020) and the COVID-19 period (April 2020 to March 2021). Statistical analysis was done using Stata version 13. Comparisons were made between the COVID-19 period and the pre-COVID-19 period, and data were presented as frequencies, percentages, and percentage differences. Overall, 3 870 presumptive TB cases were screened from April 2020 to March 2021 versus 5 804 screened from April 2019 to 2020, representing a 33.3% decrease. The decline was greater in females compared with males (38.6% versus 18.7%; p<0.05) respectively, and among adults compared with children (36.3% versus 14.7%, p<0.05), respectively. TB testing declined by 37.2% and 34.6% in health facility-initiated referrals and community-initiated referrals respectively. On an encouraging note, laboratory-confirmed TB cases increased by 13.5% during the COVID-19 period though they were a 37.3%, and 22% decrease from April to June and July to September coinciding with the expiry of Xpert MTB/RIF assays cartridges. From April 2020 to March 2021, TB case notifications declined by 5.8%, with a precipitous drop of 41% in the second quarter. The treatment success rates slightly declined throughout the COVID-19 period (90.5% versus 88.6%, p=0.391) with lower rates of LTFU (2.5% versus 1.1%), and slightly high rate of not evaluated (0.5% versus 2.1%) compared with the baseline period. The study also found that the mode of diagnosis (p<0.05) and type of DOT (p<0.01) were statistically significantly associated with treatment success, with bacteriologically confirmed cases increasing by 15.6% over the 12 months of COVID-19. Findings further indicated that the health facility directly observed therapy decreased by 84% whereas the community directly observed therapy increased by 1.4% over the 12 months of the COVID-19 pandemic. A positive change in community treatment was largely attributed to the strengthened use of community health workers in providing adherence and treatment support. Shortened TB clinic hours, temporal closure of TB clinics, movement restrictions, and transportation difficulties among other possible reasons could have led to the drop in the use of the health-facility DOT approach. These results may hold policy implications for the DOTS approach in the Buhera district and suggest the need for more resources to minimize interruption of TB service delivery during and in future pandemics.