Impact of COVID-19 Pandemic on Tuberculosis Preventive Services and Their Post-Pandemic Recovery Strategies: A Rapid Review of Literature

Abstract

Background: Coronavirus disease 2019 (COVID-19) pandemic has disrupted tuberculosis (TB) care and prevention around the world. The aim of this study is to review literature on the impact of COVID-19 on TB preventive services and discuss their policy options during and after the pandemic.

Methods: We conducted a rapid review of scientific literature on the impact of COVID-19 on TB preventive services and their recovery strategies. After conducting a line-by-line open coding, their codes were applied in the descriptive theme building process, which was guided by the End TB strategy. TB preventive measures were selected and classified into five analytical categories: 1) vaccination against TB, 2) detection and treatment of latent TB infection (LTBI), 3) screening and diagnostics, 4) active case finding and contact tracing, and 5) surveillance.

Results: We identified 93 articles, of which 65 were research articles. During the pandemic, we observed decrease in Bacillus Calmette-Guérin (BCG) coverage, TB diagnostic services, case finding activities, and LTBI management. TB case detection was declined, which was not resumed to the pre-pandemic level after loosening the lock-down. Several recommendations were highlighted: 1) secure BCG stocks and its supply chains, 2) consider catch-up activities of routine immunization and LTBI screening, 3) maintain minimal TB health services, infection prevention and control, and surveillance, 4) leverage laboratory capacity and contact tracing mechanisms, 5) consider simultaneous testing for TB and COVID-19, and 6) Incorporate digital health technologies.

Conclusions: Our findings and lessons learnt from the pandemic can aid in the development of future national TB control program.

Keywords: Health Policy; Immunization; Latent Tuberculosis; Prevention and Control; SARS-CoV-2; Screening; Surveillance.

Fig. 1. Article selection process for a rapid review on impact of the COVID-19 pandemic on tuberculosis prevention services.

COVID-19 = coronavirus disease 2019, TB = tuberculosis.

Fig. 2. Tuberculosis prevention thematic framework, which was applied in the knowledge synthesis, and their final analytical categories and codes.

Dashed lines indicate selecting preventive measures from each pillar of the WHO End TB Strategy. Dotted lines indicate linking similar characteristics of preventive measures. Solid lines indicate merging codes into categories and themes. WHO = World Health Organization, TB = tuberculosis, UHC = universal health coverage, LTBI = latent tuberculosis infection, BCG = Bacille Calmette-Guérin.