Risk factors for disruptions in tuberculosis care in Uganda during the COVID-19 pandemic

Peter D Jackson; Stella Zawedde Muyanja; Isaac Sekitoleko; Mudarshiru Bbuye; Madeline Helwig; Roma Padalkar; Mariam Hammad; Dennis Hopkinson; Trishul Siddharthan

doi:10.1371/journal.pgph.0001573

Risk factors for disruptions in tuberculosis care in Uganda during the COVID-19 pandemic

PLOS Glob Public Health. 2023 Jun 2;3(6):e0001573. doi: 10.1371/journal.pgph.0001573. eCollection 2023.

Authors

Affiliations

¹ Division of Pulmonary and Critical Care, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America.
² Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
³ Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
⁴ London School of Hygiene and Tropical Medicine, London, England.
⁵ Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
⁶ Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America.
⁷ Rowan University School of Osteopathic Medicine, Glassboro, New Jersey, United States of America.
⁸ Division of Pulmonary and Critical Care, Department of Medicine, Duke University, Durham, North Carolina.
⁹ Division of Pulmonary and Critical Care, Department of Medicine, University of Miami, Miami, Florida, United States of America.

Abstract

During the COVID-19 pandemic, TB mortality increased while diagnoses decreased, likely due to care disruption. In March, 2020, Uganda-a country with high TB burden, implemented a COVID-19 lockdown with associated decrease in TB diagnoses. This study aims to examine patient level risk factors for disruption in TB care during the COVID-19 pandemic in Uganda. This retrospective cross-sectional cohort study included six TB clinics in Uganda. Clustered sampling included phases of TB care and three time-periods: pre-lockdown, lockdown and post-lockdown. Characteristics of patients with TB care disruption (TBCD), defined as those with > 2 months of symptoms prior to diagnosis or who missed a TB clinic, and those without TB care disruption (non-TBCD) were analyzed between time-periods. 1,624 charts were reviewed; 1322 were contacted, 672 consented and completed phone interview; pre-lockdown (n = 213), lockdown (n = 189) and post-lockdown (n = 270). TBCD occurred in 57% (385/672) of patients. There was an increase in the proportion of urban patients in the TBCD and non-TBCD groups during post-lockdown (p <0.001). There was no difference in demographics, HIV co-infection, socioeconomic status, or distance to TB clinic between TBCD and non-TBCD groups or within TBCD by time-period. There were few differences amongst TBCD and all TB patients by time-period. The increase in urban patients' post-lockdown may represent a portion of urban patients who delayed care until post-lockdown. Insignificant trends suggesting more TBCD amongst those who lived further from clinics and those without HIV-coinfection require more investigation.

Copyright: © 2023 Jackson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This project was funded by the ATS/Chest Foundation COVID-19 Diversity Grant and the VCU DOIM Pilot Grant (P.J.), partial support provided by CTSA award No. UL1TR002649 from the National Center for Advancing Translational Sciences to support data collection (P.J.). The contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.