Risk factors for disruptions in tuberculosis care in Uganda during the COVID-19 pandemic

Abstract

Background: During the COVID-19 pandemic, TB mortality increased while diagnoses decreased, likely due to care disruption. In March, 2020, Uganda—a country with high TB burden, implemented a COVID-19 lockdown with associated decrease in TB diagnoses. This study aims to examine patient level risk factors for disruption in TB care during the COVID-19 pandemic in Uganda. This retrospective cross-sectional cohort study included six TB clinics in Uganda. Clustered sampling included phases of TB care and three time-periods: pre-lockdown, lockdown and post-lockdown. Characteristics of patients with TB care disruption (TBCD), defined as those with > 2 months of symptoms prior to diagnosis or who missed a TB clinic, and those without TB care disruption (non-TBCD) were analyzed between time-periods. 1,624 charts were reviewed; 1322 were contacted, 672 consented and completed phone interview; pre-lockdown (n = 213), lockdown (n = 189) and post-lockdown (n = 270). TBCD occurred in 57% (385/672) of patients. There was an increase in the proportion of urban patients in the TBCD and non-TBCD groups during post-lockdown (p <0.001). There was no difference in demographics, HIV co-infection, socioeconomic status, or distance to TB clinic between TBCD and non-TBCD groups or within TBCD by time-period. There were few differences amongst TBCD and all TB patients by time-period. The increase in urban patients’ post-lockdown may represent a portion of urban patients who delayed care until post-lockdown. Insignificant trends suggesting more TBCD amongst those who lived further from clinics and those without HIV-coinfection require more investigation.

Spatial distribution and temporal trends of tuberculosis case notifications, Uganda: a ten-year retrospective analysis (2013–2022)

“…Globally, there was a large drop in the reported number of people newly diagnosed with TB in 2020 [ 2 ]. In our study, the decline in TB CNR in 2020 can be attributed to the COVID-19 pandemic which disrupted healthcare worldwide [ 19 , 20 ]. During this time, measures that were executed to curb the spread of COVID-19 such as banning of public transport and eventually lock down may have interfered with the population health seeking behavior hence a decline in TB diagnoses [ 21 ].…”

The effect of biomass smoke exposure on quality-of-life among Ugandan patients treated for tuberculosis: A cross-sectional analysis

“…This analysis was imbedded in a previously published study which begun February of 2022, medical records were reviewed for patients receiving TB care between September 2019–2020 at three urban and three rural TB clinics in Uganda [ 4 ]. The rural clinics included Jinja Regional Referral Hospital, Mubende Regional Referral hospital and Kiboga General Hospital.…”

Global-, Regional-, and National-Level Impacts of the COVID-19 Pandemic on Tuberculosis Diagnoses, 2020–2021

“…Previous studies have documented disruptions across the continuum of care for TB [ 13 ], with findings illustrating substantial decreases in TB screening [ 14 , 15 ], up to an extra 35-day delay in TB diagnoses [ 16 , 17 ], reductions in access to TB treatment [ 18 , 19 ], and drops in TB treatment completions [ 20 , 21 ]. Several reasons have been cited for these interruptions, including stay-at-home orders, health services being redirected to COVID-19, reduced hours of health facilities, fear of SARS-CoV-2 infection, and reductions in the ability to pay for care [ 22 , 23 ]. These disruptions have further engendered significant drops in the number of reported TB cases [ 24 , 25 , 26 ].…”