# The impact of COVID-19 pandemic in tuberculosis diagnosis in sub-Saharan Africa: data from DREAM program in Mozambique

## TL;DR

The study shows how the COVID-19 pandemic affected tuberculosis diagnosis in Mozambique, with reduced activity but stable positivity rates.

## Contribution

The paper provides new insights into the impact of the pandemic on TB diagnostic services in sub-Saharan Africa using real-world data from Mozambique.

## Key findings

- TB diagnostic activity decreased during the pandemic, but positivity rates remained stable.
- Beira had higher TB positivity and rifampicin resistance compared to Maputo.
- Diagnostic appropriateness improved in clinical centers during the pandemic.

## Abstract

TB is a global emergency, COVID-19 reversed the trend in TB mortality reduction to 2017 levels. Mozambique is one of the highest-burden countries with 368 new cases per 100.000 population in 2020.

This analysis aims to evaluate a TB diagnostic service in two Mozambican cities before and during the COVID-19 pandemic.

We reviewed routine activity data from two laboratories in Mozambique (Maputo and Beira) in the period 01/2018–08/2022. GeneXpert test was prescribed based on clinical suspicion. Data about the number of tests, results, and rifampicin resistance were collected.

In the period 3,071 tests were conducted: 391 positive, and 32 rifampicin resistant. The number of positive samples was higher in Beira (20.2% vs 5%, OR 4[3.1-5.2]).

In Maputo, we observed a higher percentage of rifampicin-resistant samples (13.2%vs7%, OR 0.5[0.2-1.1]), but the overall prevalence of rifampicin resistance was higher in Beira (14.1‰vs6.6‰, OR 2.1[1.0-4.5]).

In 2020 and the first semester of 2021 a reduction in activity was observed, but positivity rates remained stable, with a slight increment starting in 2020.

Our data confirm the impact of the COVID-19 pandemic on TB diagnostic services but also highlight possible benefits in terms of diagnostic appropriateness in clinical centers.