Assessing the effect of COVID-19 pandemic on tuberculosis (TB) healthcare service utilization, delivery and coping mechanisms at the TB Unit in Mulago National Referral Hospital, Uganda

Abstract

Introduction The coronavirus (COVID-19) pandemic affects health system resilience, one of the areas that could have been affected is Tuberculosis (TB) health care yet TB is still a very important problem which is the leading killer among the infectious diseases. In 2019 alone, it caused approximately 1.7 million deaths. Understanding the effects of COVID-19 pandemic on TB care is important to support strengthening of TB health system especially during and after the such shocks. This work contributes to understanding the extents of COVID-19 effects and the coping mechanisms in TB burdened settings. Methods This study was done at the TB clinic at Mulago National Referral Hospital. It used retrospective longitudinal study design through extraction of data from the District Health Information System 2 (DHIS2) using data abstraction tool and a qualitative approach conducted among healthcare workers and TB patients. For the qualitative approach, health workers and TB patients were purposively selected and data collected using key informant guides and in-depth interview guides. Data about the five indicators was analysed using interrupted time series analysis. Qualitative data was analysed using thematic content analysis. Results There was a decline in the case notification rate (CNR) of 6.8 cases per 100,000 (p = 0.000, (95% CI = -8.05, -5.5)), treatment success rate (TSR) of 8.68% (p = 0.000, (95% CI = -011.29, -6.07)) in the first quarter of the intense COVID-19 pandemic period. There was a decrease in the Drug resistant TB notification (DR-TB CNR) of 0.26 cases per 100,000 (p = 0.001, (95% CI = -0.41, -0.10)) and Drug resistant TB treatment success rate (DR-TB TSR) by 7.22% (p=0.045, 95% CI = -14.28, -16)) per quarter during the intense pandemic period. TB patients faced problems like stigmatization, transportation, stress and anxiety. Health workers reported shortage of staff, increased workload, and lack of personal protective equipment. Coping mechanisms include provision of home-based TB care and adoption of telemedicine services. Conclusion The COVID-19 pandemic caused a significant decline in four TB core indicators; therefore, TB program managers need to put in place policies and strategies need to improve the resilience of the TB health system during such shocks.