Retrospective Cohort Study of Effects of the COVID-19 Pandemic on Tuberculosis Notifications, Vietnam, 2020

severe acute respiratory syn- drome coronavirus 2 (SARS-CoV-2) has been causing a global coronavirus disease pandemic that has had wide-reaching effects on delivery of care for many other health conditions, including tuberculosis (TB). Each year, 10 million TB cases are diagnosed and 1.5 million TB deaths occur worldwide (1). The World Health Organization (WHO) has identifi ed substantial effects of the COVID-19 pandemic on TB control efforts (1). By late 2020, substantial reductions in TB case notifi cations were evident in both high-and middle-income countries (2-6), including countries where COVID-19 had been well-controlled (7). Decreased TB notifi cations led to fears that delays in case detection and reduced treatment completion resulting from the COVID-19 pandemic might lead to increased Mycobacterium tuberculosis transmission and consequently higher mortality rates (8). Indeed, evidence suggests that the COVID-19 pandemic has resulted in reduced patient adherence to treatment (9), decreased access to medications (10,11), delayed access to services (10,12), and higher rates of loss to follow-up for patients with TB (10). Some of this disruption has been attributed to diversion of resources and interruptions to drug supply and delivery resulting from the COVID-19 pandemic (13). Furthermore, some persons with TB have avoided seeking healthcare because of fear of acquiring . In addition, evidence from South Africa suggests that outcomes for SARS-CoV-2 infection are worse for patients co-infected with TB (15).