Impact of COVID-19 on the cascade of care for tuberculosis: A systematic review

Abstract Objectives To describe the impact of the COVID-19 pandemic on the TB care cascade. Methods In this systematic review, the Cochrane library, Scopus, CINAHL, Ebscohost, and PubMed databases were comprehensively searched from the onset of the pandemic, till May 5 th , 2022. Eligible studies were those reporting on changes in the TB cascade of care one year before and one year during the COVID-19 pandemic. Due to the expected differences in the contexts of the included studies, a narrative synthesis was conducted. Results Twenty-seven studies, from Asia, North America, Africa, South America, and Europe were included. TB screening decreased by between 1% - 50%, and multidrug resistance tuberculosis (MDR-TB) screening decreased by between 15%-17%. Diagnostic delay increased by between 35 - 45 days, contact tracing decreased by up to 36.1%, and case notification decreased by between 3%-63%. TB treatment enrolment decreased by between 16%-35.0%, treatment completion decreased by around 8.0% and treatment success decreased by up to 17.0%. Conclusion COVID-19 had a detrimental impact on the TB care cascade and these findings suggest a need for policies to protect healthcare systems for TB and other communicable diseases in future health emergencies. Protocol registration - PROSPERO: CRD42021272456 Ethics approval This systematic review used data from published studies and aggregated data, thus, ethics approval was not required.