From Progress to Disruption: Unveiling the Hidden Impact of COVID-19 on Tuberculosis Indicators in India

Background To assess the impact of the COVID-19 pandemic on key TB indicators in India by comparing TB notification performance before and during the pandemic, and to inform strategies for integrating TB services into emergency preparedness and strengthening health system resilience. Methods This study analysed 13 critical TB indicators, such as incidence, case notifications, drug resistance, and TB-related mortality, using data from the India TB Report and WHO estimates. An interrupted time-series analysis and linear generalised estimating equations were conducted to evaluate the impact of COVID-19 on TB trends by comparing the pre-pandemic period (2000–2019) with the pandemic period (2020–2023), capturing immediate disruptions and long-term changes in public primary healthcare indicators. Results The study observed substantial disruption in TB-related notifications during the pandemic, with the most pronounced impact in 2020. Though notifications gradually improved, most remained below pre-pandemic levels by 2023. Significant reductions were noted in TB incidence (up to 18.6%), total TB cases (up to 53%), and paediatric TB (up to 45%). Notifications of drug-resistant forms of RR-TB and MDR/RR-TB declined by up to 36.6% and 34.2%, respectively. Post-pandemic increases were seen in TB-HIV co-infection, extrapulmonary TB, and rifampicin-resistant TB (up to 34.6%). TB-related mortality surged, with all forms of TB deaths rising by 85.6% and HIV-associated TB deaths increasing by nearly 97% in 2020 alone. Conclusions COVID-19 sharply disrupted TB notifications in India. Despite partial recovery, indicators remain below pre-pandemic levels. Strengthening TB programs and building resilient health systems is vital to ensure continuity of care during health emergencies.