Tuberculosis service delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: a qualitative study
Objective To describe challenges posed by COVID-19 on tuberculosis (TB) commodity supply, care cascade, active case finding and responses taken by healthcare workers (HCWs) and community health workers (CHWs) during the first year of the pandemic (March 2020 to February 2021).Design A qualitative de...
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BMJ Publishing Group
2025-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/4/e094564.full |
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| author | Nyanda Elias Ntinginya Lucas Maganga Doreen Pamba Issa Sabi Erica Samson Sanga Willyhelmina Olomi Happiness Mvungi Riziki Kisonga Emmanuel Matechi Hamim Omary Wiston William Theresia Setebe Chacha Mangu Robert Balama Allan Tarimo |
| author_facet | Nyanda Elias Ntinginya Lucas Maganga Doreen Pamba Issa Sabi Erica Samson Sanga Willyhelmina Olomi Happiness Mvungi Riziki Kisonga Emmanuel Matechi Hamim Omary Wiston William Theresia Setebe Chacha Mangu Robert Balama Allan Tarimo |
| author_sort | Nyanda Elias Ntinginya |
| collection | DOAJ |
| description | Objective To describe challenges posed by COVID-19 on tuberculosis (TB) commodity supply, care cascade, active case finding and responses taken by healthcare workers (HCWs) and community health workers (CHWs) during the first year of the pandemic (March 2020 to February 2021).Design A qualitative descriptive study involving 25 in-depth interviews and 10 focus group discussions conducted in July 2022.Setting 37 TB treatment facilities were purposively selected from seven regions due to high TB case notifications in 2019 and their provision of TB and COVID-19 services during the first year of the pandemic (March 2020 to February 2021).Participants Purposive selection of 58 HCWs and 55 CHWs who provided TB services in the first year of the COVID-19 pandemic.Results HCWs reported unusual stockouts and delayed receipt of GeneXpert cartridges and sputum containers. TB services faced a decline in client attendance, as clients were hesitant to undergo TB screening, sputum sample collection and contact tracing due to fear of contracting or being diagnosed with COVID-19 and subsequently being quarantined. To mitigate these challenges, HCWs used alternative containers for sputum sample collection, optimised GeneXpert cartridge use by prioritising GeneXpert testing for TB risk groups and diagnosed TB by microscopy, chest X-ray and sputum pooling method. Moreover, they extended drug refill schedules to minimise the risk of contracting COVID-19 in clinics. CHWs used mobile communication for client tracing and focused household visits on TB risk groups.Conclusion COVID-19 disrupted TB commodity availability and TB treatment-seeking behaviour. Adaptations like multi-month drug refills and optimised GeneXpert use supported the TB healthcare system’s resilience. While these adaptations offer valuable insights for strengthening TB service delivery, their effectiveness and sustainability require further evaluation. Thus, prospective studies could clarify their long-term impact. National Tuberculosis Program could consider adapting these practices postpandemic, with appropriate modifications to suit different contexts. |
| format | Article |
| id | doaj-art-b4a6cd7afa33490dbc4ac8d1df7c7e16 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-b4a6cd7afa33490dbc4ac8d1df7c7e162025-08-20T02:12:29ZengBMJ Publishing GroupBMJ Open2044-60552025-04-0115410.1136/bmjopen-2024-094564Tuberculosis service delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: a qualitative studyNyanda Elias Ntinginya0Lucas Maganga1Doreen Pamba2Issa Sabi3Erica Samson Sanga4Willyhelmina Olomi5Happiness Mvungi6Riziki Kisonga7Emmanuel Matechi8Hamim Omary9Wiston William10Theresia Setebe11Chacha Mangu12Robert Balama13Allan Tarimo14National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania5NIMR-Mbeya Medical Research Center3 National Institute for Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania, United Republic ofNational Institute for Medical Research-Mbeya Medical Research Center, Mbeya, TanzaniaMbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, United Republic of Tanzania7 Data Management, Mbeya Medical Research Center, Mbeya, Tanzania, United Republic of2 Medical, Kibong’oto Infectious Diseases Hospital, Sanya Juu, Tanzania, United Republic of5 Medical, Kibong’oto Infectious Diseases Hospital, Kilimanjaro, Tanzania, United Republic of6 National Tuberculosis and Leprosy Programme, Dodoma, Tanzania, United Republic of6 National Tuberculosis and Leprosy Programme, Dodoma, Tanzania, United Republic ofNational Institute for Medical Research-Mbeya Medical Research Center, Mbeya, TanzaniaNational Institute for Medical Research-Mwanza Medical Research Center, Mwanza, TanzaniaNational Institute for Medical Research-Mbeya Medical Research Center, Mbeya, TanzaniaNational Tuberculosis and Leprosy Control Programme, Dodoma, TanzaniaNational Tuberculosis and Leprosy Control Programme, Dodoma, TanzaniaObjective To describe challenges posed by COVID-19 on tuberculosis (TB) commodity supply, care cascade, active case finding and responses taken by healthcare workers (HCWs) and community health workers (CHWs) during the first year of the pandemic (March 2020 to February 2021).Design A qualitative descriptive study involving 25 in-depth interviews and 10 focus group discussions conducted in July 2022.Setting 37 TB treatment facilities were purposively selected from seven regions due to high TB case notifications in 2019 and their provision of TB and COVID-19 services during the first year of the pandemic (March 2020 to February 2021).Participants Purposive selection of 58 HCWs and 55 CHWs who provided TB services in the first year of the COVID-19 pandemic.Results HCWs reported unusual stockouts and delayed receipt of GeneXpert cartridges and sputum containers. TB services faced a decline in client attendance, as clients were hesitant to undergo TB screening, sputum sample collection and contact tracing due to fear of contracting or being diagnosed with COVID-19 and subsequently being quarantined. To mitigate these challenges, HCWs used alternative containers for sputum sample collection, optimised GeneXpert cartridge use by prioritising GeneXpert testing for TB risk groups and diagnosed TB by microscopy, chest X-ray and sputum pooling method. Moreover, they extended drug refill schedules to minimise the risk of contracting COVID-19 in clinics. CHWs used mobile communication for client tracing and focused household visits on TB risk groups.Conclusion COVID-19 disrupted TB commodity availability and TB treatment-seeking behaviour. Adaptations like multi-month drug refills and optimised GeneXpert use supported the TB healthcare system’s resilience. While these adaptations offer valuable insights for strengthening TB service delivery, their effectiveness and sustainability require further evaluation. Thus, prospective studies could clarify their long-term impact. National Tuberculosis Program could consider adapting these practices postpandemic, with appropriate modifications to suit different contexts.https://bmjopen.bmj.com/content/15/4/e094564.full |
| spellingShingle | Nyanda Elias Ntinginya Lucas Maganga Doreen Pamba Issa Sabi Erica Samson Sanga Willyhelmina Olomi Happiness Mvungi Riziki Kisonga Emmanuel Matechi Hamim Omary Wiston William Theresia Setebe Chacha Mangu Robert Balama Allan Tarimo Tuberculosis service delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: a qualitative study BMJ Open |
| title | Tuberculosis service delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: a qualitative study |
| title_full | Tuberculosis service delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: a qualitative study |
| title_fullStr | Tuberculosis service delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: a qualitative study |
| title_full_unstemmed | Tuberculosis service delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: a qualitative study |
| title_short | Tuberculosis service delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: a qualitative study |
| title_sort | tuberculosis service delivery challenges and their mitigations during the covid 19 pandemic in tanzania a qualitative study |
| url | https://bmjopen.bmj.com/content/15/4/e094564.full |
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