The Impact of COVID-19 on Tuberculosis Program Performance in the Kingdom of Lesotho

Abstract

Background: As tuberculosis (TB) is an airborne disease requiring multi-month therapy, systems of TB detection and care were profoundly impacted by the COVID-19 pandemic. The worsening economic situation, including income, food, and housing insecurity, impacted the social conditions in which TB—already a leading killer in resource-limited settings—thrives. This study assesses the impact of COVID-19 on TB detection and treatment in Lesotho. Methods: We used routine program data from 78 health facilities in Lesotho. We created time series models from July 2018 to March 2021 to quantify COVID-19-related disruptions to TB program indicators: outpatient visits; presumptive, diagnosed, treated, and HIV co-infected cases; and treatment outcomes including successful (cured and completed) and unsuccessful (death and treatment outcome unknown). Results: We observed a significant decline in cumulative outpatient visits (−37.4%, 95% prediction interval [PI]: −40.1%, −28.7%) and new TB cases diagnosed (−38.7%, 95%PI: −47.2%, −28.4%) during the pandemic, as well as TB-HIV co-infections (−67.0%, 95%PI: −72.6%, −60.0%). However, we observed no difference in treatment success (−2.1%, 95%PI: −17.0%, 15.8%). Conclusions: TB case detection in Lesotho fell during the COVID-19 pandemic, likely related to the uptake of overall health services. However, treatment success rates did not change, indicating a strong health system and the success of local strategies to maintain treatment programs.

Keywords

• COVID-19
• tuberculosis
• essential health services
• time series modeling
• health policy