Primary health care response to tuberculosis treatment in Brazilian citiesduring the COVID-19 pandemic: a mixed-method study

Abstract

Background: The interruption of tuberculosis care and monitoring activities during theCovid-19 pandemic resulted in delays in diagnosis and treatment of this disease, whichcompromised progress towards the goal of elimination.Objectives: Analyze tuberculosis-related activities offered in primary health care settings inBrazil during 2020–2022Methods: This mixed-method convergent parallel study was conducted in four state capitals,with the number of health units defined by sample calculation. Professionals in various areaswere interviewed as key informants in primary care services to investigate tuberculosis-related activities provided during the pandemic. Using these findings, we identified commonthemes in both the quantitative and qualitative dataResults: Four major themes were identified: ‘Consultations for people undergoing tuberculosistreatment within the context of health reorganization;’ ‘Compromised testing and surveillance;’‘Drug dispensing in collaborative activities to reduce the exposure of people undergoing treatment;’and ‘Changes in directly observed therapy to reduce infection risk.’ Changes in the tuberculosis-related activities were identified in all four cities during the study period; the mean rates of changewere lowest in São Paulo and higher in Goiânia and João Pessoa for nearly all the activities offered.Conclusions: Structural barriers must be identified in each city (such as laboratory networkfunction, reorganization strategies, and local and national directives) to address specific needsrelated to tuberculosis care during emergency situations and continue progress towardeliminating this disease.