Tuberculosis services delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: A qualitative study

Objective

To describe challenges posed by COVID-19 on TB commodity supply, care cascade, active case finding, and responses taken by healthcare workers (HCWs) and community health workers (CHWs) during the first year of the pandemic (March 2020 to February 2021).

Design

A qualitative descriptive study involving 25 in-depth interviews and 10 focus group discussions conducted in July 2022.

Setting

37 TB treatment facilities were purposively selected from seven regions due to high TB case notifications in 2019 and their provision of TB and COVID-19 services during the first year of the pandemic (March 2020 to February 2021).

Participants

Purposive selection of 58 HCWs and 55 CHWs who provided TB services in the first year of the COVID-19 pandemic.

Results

HCWs reported unusual stockouts and delayed receipt of GeneXpert cartridges and sputum containers. TB services faced a decline in client attendance, as clients were hesitant to undergo TB screening, sputum sample collection, and contact tracing due to fear of contracting or being diagnosed with COVID-19 and subsequently being quarantined. To mitigate these challenges, HCWs used alternative containers for sputum sample collection, optimized GeneXpert cartridges use by prioritizing GeneXpert testing for TB risk groups, and diagnosed TB by microscopy, chest X-ray, and sputum pooling method. Moreover, they extended drug refill schedules to minimize the risk of contracting COVID-19 in clinics. CHWs used mobile communication for client tracing and focused household visits on TB risk groups.

Conclusion

COVID-19 disrupted TB commodity availability and TB treatment-seeking behavior. Adaptations like multi-month drug refills and optimized GeneXpert use, supported the TB healthcare system’s resilience. While these adaptations offer valuable insights for strengthening TB service delivery, their effectiveness and sustainability require further evaluation. Thus, prospective studies could clarify their long-term impact. National Tuberculosis Programs could consider adapting these practices post-pandemic, with appropriate modifications to suit different contexts.

STRENGTHS AND LIMITATIONS OF THIS STUDY

• The study provides insights into healthcare providers’ TB management experiences during the first year of COVID-19.

• Purposive sampling provided insights into TB service delivery across diverse healthcare cadres and facilities in high-COVID-19 regions.

• Triangulation of data collection methods and researchers enhanced credibility by ensuring data consistency and reducing potential bias.

• Retrospective data collection may have introduced recall bias but mitigated through data triangulation.

• Focusing on high-COVID-19 regions may limit the transferability of findings to less COVID-19 affected areas with different TB service challenges.