Patterns of tuberculosis case notification and treatment outcomes in the context of COVID-19 pandemic: analysis of national surveillance data, January 2019 - June 2021

Background Tuberculosis case notification is critical for TB control but can be disturbed by interruptions to normal health system functioning. The first major wave of COVID-19 in Uganda occurred during August-December 2020. The government-imposed lockdown measures during March-June 2021 which required residents to stay at home. We determined the effect of COVID-19 and associated lockdown on TB case notification rates (CNR) and treatment success rates (TSR). Methods We analysed TB CNR and TSR data for January 2019-June 2021 from the Uganda District Health Information Software version2 (DHIS2) and disaggregated them by region. We also compared data on the COVID-19 cases with the TSR, and CNR trends over the period. We computed the CNR per 100,000 population, defined as number of notified TB cases/100,000 population. TSR was defined as the proportion of patients initiated on TB treatment that successfully completed treatment or cured. We described the quarterly trends and distribution of CNR and TSR pre (January 2019-March 2020) and during COVID-19 (April 2020-June 2021). We used interrupted time series analysis to determine the significance of the trends before and during COVID-19. We defined time periods by year (2019, 2020, or 2021) and quarter. Results The overall TB CNR between January 2019 and June 2021, was 165/100,000; TSR was 79.4%. CNR ranged from 166.2/100,000 pre COVID-19 to 164/100,000 during COVID-19. CNR declined significantly by 22% (p = 0.042, CI= [-41.4, -1.1]) from January 2020 to April 2020, concurrent with the lockdown and rising COVID-19 cases and was primarily driven by the sharp decline from 426/100,000 to 265/100,000 in Kampala City. This was followed by a significant quarterly increase in the national CNR of 16/100,000 (p < 0.001, CI= [10.0,21.6]), and 39/100,000 (p = 0.01, CI= [15.66,62.32]) in Kampala. TSR increased significantly by 1.6% (p < 0.0001,95%CI 1.3–1.9%) quarterly. Conclusion CNR appeared to be affected by the initial lockdown but recovered quickly. However, this decline was heavily driven by declines in CNR in Kampala City whose trends are not reflective of the rest of the country. TSR increased over time but was still below the 90% target. There is need to focus on continuity of TB care interventions in areas heavily affected by lockdowns.