141 6 Tuberculosis services during the Covid-19 pandemic 1. Introduction At the peak of the COVID-19 pandemic in 2020, tuberculosis (TB) case notifications dropped by as much as 47%.1 Many TB high-burden countries continue struggling to recover as newer COVID-19 variants arise and impact resource allocation and service delivery.2,3 Impacts include the closure of health facilities and laboratories, healthcare workers becoming sick, stock out of medical supplies, and repurposing of existing facilities and staff. Additionally, an impact modelling study demonstrated there could be an increase of up to 20% in TB-related deaths due to delayed diagnosis over the next five years.4 Data from different WHO regions indicate access to other health services including HIV, malaria, vaccination, non-communicable diseases, and mental health were affected.5–8 The responses to address the impact of COVID-19 on these services including TB varied by country, especially noting wide differences in health systems and existing infrastructure before the pandemic. Associated with the public health response was the economic meltdown caused by the global shutdown and restriction in both local and international movements to limit new infections.9 Like other countries, the declaration of COVID-19 as a global pandemic in March 2020 by WHO activated a national response in Eswatini which mandated the use of face masks, hand washing and sanitization, closure or limited operations at some institutions and the general restriction in movement.10 These measures affected access to healthcare including TB services. In this paper, we describe the impact of the COVID-19 pandemic on TB service delivery and different practices adopted by healthcare workers in Eswatini to ensure continued services. 2. Methods 2.1 Context TB services in Eswatini are coordinated by the ministry of health (MOH) through the National Tuberculosis Control Programme (NTCP).11 The NTCP oversees TB services through a network of primary care clinics, health centres and regional hospitals where every patient is screened for TB regardless of the primary complaint. Drug-sensitive TB patients are managed at the primary care clinics while those with multi-drug resistant TB are initially treated at one of the regional hospitals and down referred to the primary care clinic when they achieve sputum conversion.
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