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

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.