The effect of COVID-19 on TB case detection and treatment outcomes in Ethiopia, Addis Ababa city.

Abstract Background: In the context of the global tuberculosis (TB) epidemic, the COVID-19 pandemic threatens to reverse promising progress toward global TB targets. During the pandemic, similar to most countries, the Ethiopian government announced movement restrictions targeting the control of the spread of COVID-19. Methods: A quantitative retrospective study was used based on secondary data collected from the Addis Ababa city-Health Bureau DHIS-2 database for a study period of four years (April/2018-March/2021). Two-year pre- and two intra-COVID-19 periods. The study area included all health facilities providing TB care in Addis Ababa. The data were collected using a structured format, and analysis was performed using STAT version 17 and Excel software. Result. Overall, 13190 TB cases were detected during the COVID-19 era and 15038 in pre-COVID-19, representing a 12.3% decline with P= 0.0092. The highest decrease was in Q-1 and Q-2 by (30% and 29.8%) CI 95% during COVID-19 in the first year and in the second year in Q-4 by 21.2%. All forms of TB case notifications were significantly decreased (P< 0.001). RELAPSE and clinically diagnosed TB showed the highest decrease (30%, P<0.001 and 20.6%, P<0.001) CI 95%. Of TB treatment outcomes, completed, lost to follow-up and death rates had better outcome rates during the COVID-19 era. In the first year after the COVID-19 pandemic, the TB treatment completion rate was higher (63.8% vs. 60%, P=0.0001) (CI 95%), with a lower rate of loss to follow-up (1.8% vs 1.9%, P=0.659) and death rate (3.8% vs 4.8% P=0.0034). In the second year after the COVID-19 pandemic, the TB treatment completion rate was higher (64.5% vs. 62.4%, P= 0.0003), with a lower rate of loss to follow-up (1.7% vs 1.9%, P=0.2036) and death rate (4.3% vs 4.6%, P=0.2232). Conclusion Finally, the unpredicted study finding of treatment outcomes had the potential to change the existing DOT treatment policy in Ethiopia. In view of this, further study in a broader context at the health minister level is recommended. Moreover, to mitigate the catastrophic impact of the COVID-19 pandemic on TB case detection, improving access to quality TB care services is mandatory to enhance TB detection. Ultimately, it is able to reverse the catastrophic impact of the COVID-19 pandemic on TB care program activities in Addis Ababa, Ethiopia.