Impacts of COVID-19-Related Service Disruptions on TB Incidence and Deaths in Indonesia, Kyrgyzstan, Malawi, Mozambique, and Peru: Implications for National TB Responses

Background: This modeling study aims to measure the impact COVID-19-related tuberculosis (TB) service disruptions had on key TB outcomes in Indonesia, Kyrgyzstan, Malawi, Mozambique, and Peru, and the mitigation of that impact through catch-up strategies in each country. Methods: Quarterly epidemiological estimates and programmatic TB data capturing disruption levels to each TB service were collected by National TB Programmes (NTPs) in 2019, for a pre-COVID-19 baseline, and throughout 2020. These data, together with the NTP’s COVID-19 response plans, were used within Optima TB models to project TB incidence and deaths over five years. Findings: Countries reported disruptions of up to 64% to passive TB case finding. TB treatment experienced lower levels of disruption of up to 21%. We predicted that under the worse-case scenario new latent TB infections, new active TB infections, and TB-related deaths could increase by up to 23%, 11%, and 20%, respectively, by 2024. However, three of the five countries were on track to mitigate these increases to 3% or less by maintaining TB services in 2021 and 2022 and by implementing proposed catch-up strategies thereafter. Indonesia was already experiencing the worse-case scenario, which could lead to 270,000 additional active TB infections and 36,000 additional TB-related deaths by the end of 2024. Interpretation: The COVID-19 pandemic is projected to negatively affect progress towards 2035 End TB targets, especially in countries already off-track. Findings highlight the need to proactively maintain TB service availability under a range of scenarios, including potential new waves of COVID-19 caused by more transmissible variants. Funding Information: UNAIDS Declaration of Interests: None to declare.