Impact of Covid-19 lockdown on multi-drug resistant tuberculosis case notifications and treatment outcomes at multi-drug resistant tuberculosis treatment centers in Uganda.

Abstract

Background: Multi-drug Resistant Tuberculosis (MDR-TB) is currently a public health threat with an incidence of 6.3% reported globally in 2020. In Uganda, an incidence of 12.0% was reported among previously treated and 1.4% among new cases in 2018. Covid-19 and drastic measures to curb its transmission like lockdowns impacted the health sector globally. Little is known about the impact of the Covid-19 lockdown on MDR-TB in Uganda. Objectives: The study aimed to assess the impact of the Covid-19 lockdown on MDR-TB case notifications and treatment outcomes at MDR-TB treatment centers in Uganda by comparing MDR-TB case notifications and treatment outcomes before and during Covid-19 lockdown. Methods: We compared MDR-TB case notifications and treatment data before (March 2017-February 2020) and during (March 2020-February 2022) by reviewing data from individual-level drug-resistant tuberculosis (DR-TB) Health Management Information System (HMIS) and patient charts. The main outcome was MDR-TB case notifications and treatment outcomes classified as successful and unsuccessful treatment outcomes. Mean MDR-TB case notifications before and during the Covid-19 lockdown were compared using Wilcoxon rank-sum test. Monthly MDR-TB case notifications were compared using interrupted time series analysis (ITSA). Proportions of successful treatment outcomes of MDR-TB before and during the Covid-19 lockdown were compared using the chi-squared test. Predictors of successful MDR-TB treatment outcomes were assessed using modified Poisson regression. Results: A total of 604 participants were enrolled for the period between March 2017 to February 2022. Out of these, 359 were before (March 2017-February 2018) and 245 were during (March 2018-February 2022) Covid-19 lockdown. The majority were males; 71.4% (during) and 68.0% (before) Covid-19 lockdown. For the periods, 24 months before lockdown (March 2018-February 2020) and 24 months during lockdown (March 2020-February 2022), there was no significant difference in the mean monthly MDR-TB case notifications before (9.96) and during (10.17) the Covid-19 lockdown (p-value 0.869). The proportions of successful MDR-TB treatment outcomes before (81.5%) and during (81.7%) Covid-19 lockdown were not significantly different (p-value 0.590). Being single (PR 0.85, 95% CI: 0.74, 0.97) and treatment delay greater than 7 days (PR 0.87, 95% CI 0.78, 0.96) were negatively associated with successful treatment outcome. Conclusion: Covid-19 lockdown did not affect MDR-TB case notifications and treatment outcomes in this setting. We found that being single and having treatment delay greater than 7 days reduced the chances of successful treatment outcome. These findings imply that the systems for case notifications and treatment put in place by Ministry of Health (MOH) during the lockdowns were resilient. National TB and Leprosy program (NTLP) should continue strengthening systems targeting high risk groups like minors and people with a history of TB.