153 6 Tuberculosis services during the Covid-19 pandemic Table 3: Illustrative quotes from the participants in the study Sub-theme Quotes 3.2.2 COVID worsened the health system challenges “… much attention was given to COVID-19 such that other medications were out of stock which hampered the control of the chronic conditions, at times patients were getting their medications at the comfort of their homes without a medical practitioner to ensure if their condition is getting better or worsening” R5 “The availability of drugs during COVID-19 was also a challenge from the suppliers as well.” R11 “…most patients who screened positive for COVID-19 were also sent to the TB department, hence they were flooding the department... both the confirmed and the presumptive TB cases are seen by the same person due to the associated symptoms of TB and COVID-19… we were seeing that challenge of the shortage of staff during COVID-19 surge …” R21 3.2.4 Patients defaulted due to the lockdown “… what happened is that patients were not coming to the facility hence we were missing cases, and some patients were defaulting.” R9 “During COVID-19 many of our patients defaulted and we had many lost to followup due to lockdown and the travel restrictions which were put in place. There was no transport to do home-based care visits” 17 “When COVID-19 started, movement was restricted hence it affected the patients who were coming to our facility” R20 3.2.5 COVID impacted the quality of care “Due to COVID-19 we were limiting the amount of time the patient would spend in the facility, such that we were not checking the blood pressure, even some processes that were followed before were not followed in the COVID era such that it was easy to miss a TB patient who has COVID or even misdiagnose a patient.” R3 “The standard of care to patients declined especially if a patient was diagnosed with COVID-19, thus the time spent with the patient was reduced” R7 “Since COVID and TB almost share the same symptoms, all the TB and COVID patients are reviewed by one nurse which has increased the volume (of patients) seen by the nurse thus increasing the waiting period as well.” R20 “We normally face delayed transportation of samples to the national lab... The ambulance is not always available for emergencies which can affect the standard of care” R19 “… we sometimes have a problem with our GeneXpert machine and sometimes we run out of TB-lam… There is no proper follow-up on culture, sometimes we send, and the results do not come back” R20 3.3.2 Patient support “… we have our treatment supporter who also provides counselling to our patients… we do provide transport money to our patients so that they cannot be frustrated when it’s time for refills...” R8 “COVID-19 did affect us but not that much, most of our TB patients were coming and if they didn’t come, we call them, and if they are far, we used their nearest facility for refills” R12 “…We are also giving food parcels to our patients who are both TB and HIV positive to improve their nutrition because most of our patients are struggling with nutrition” R21
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