COVID-19 impact on health service- and TB-related practices among private providers in Indonesia

Setting The COVID-19 pandemic has caused disruptions to healthcare services worldwide, including in private healthcare facilities (HCFs), where TB patients mostly initiate their care-seeking journey. Objective To identify adjustments to TB-related practices made by HCFs during the pandemic. Design We identified, contacted and invited private HCFs across West Java, Indonesia, to fill an online questionnaire. The questionnaire explored participants' sociodemographic characteristics, adaptations and TB management practices implemented in their facilities during the pandemic. Data were analysed using descriptive statistics. Results Of the 240 HCFs surveyed, 40.0% shortened their operational hours and 21.3% have ever closed their practices during the pandemic; 217 (90.4%) made adjustments to keep delivering services, 77.9% by requiring the use of personal protective equipment (PPE); 137 (57.1%) observed fewer patient visits; 140 (58.3%) used telemedicine, a few of which (7.9%) ever handled TB patients on that platform. Respectively 89.5%, 87.5% and 73.3% of HCFs referred patients for chest radiography, smear microscopy and Xpert testing. Only a median of 1 (IQR 1-3) TB patient per month was diagnosed by the HCFs. Conclusion Two major adaptations rolled out during COVID-19 were the use of telemedicine and PPE. Optimisation of the diagnostic referral system to increase TB case detection in private HCFs is warranted.