143 6 Tuberculosis services during the Covid-19 pandemic sub-themes and similar sub-themes were grouped into major themes for the study (VW, MC). Three research team members reviewed the code book and the themes for accuracy and consistency. Inaccuracies in the codes, sub-themes, and themes were resolved in a study meeting. Reviewing the codes was iterative to ensure the finalized themes were accurate. The results were presented using text analysis. NVivo 12 software was used for qualitative analysis and the Consolidated Criteria for Reporting Qualitative research (COREQ) guided the reporting of this study.13,14 (Supplementary file 2). Results 3.1 Characteristics of respondents Twenty-two healthcare workers from ten healthcare facilities participated in the interview (Table 1). Although two participants from one health facility were not available for interviews, data saturation was achieved. Data from the interviews indicate two themes which describe the healthcare worker's perspectives on the impact of COVID-19 on TB services delivery and access and best practices which enabled services delivery during the COVID-19 pandemic. The different themes and subthemes are summarized in Table 2. 3.2 COVID-19 impacted services delivery and access 3.2.1 All attention focused on COVID Most participants stated many aspects of healthcare delivery were deprioritized at the start of the COVID-19 pandemic. Services were implemented partially or suspended. “More attention was given to COVID-19, sputum was not collected due to COVID-19 hence many patients who were TB+ were lost in the process since patients were only screened mostly for COVID-19. Many patients who came with NCDs during the COVID-19 phase missed out because we were afraid of conducting some of the tests” R1 “Sputum induction was stopped due to the pandemic since we were in fear of the exposure to COVID-19” R2 3.2.2 COVID worsened the health system challenges Respondents observed that existing health system-related challenges worsened during the pandemic including disruptions in the supply of drugs and consumables and shortages of healthcare workers (Table 3).
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