P133 Impact of the COVID-19 pandemic on tuberculosis rapid access service provision, diagnosis and treatment outcomes

<h3>Introduction</h3> Disruption to tuberculosis (TB)-control programmes caused by restricted and virtual access to healthcare during the COVID-19 pandemic remains to be fully characterised. <h3>Objectives</h3> To evaluate performance and patient outcomes of the reconfigured virtual rapid access TB (RATB) service at Leicester (UK), comparing periods before, during and after the pandemic. <h3>Methods</h3> Retrospective analysis of patient referrals to Leicester RATB services and outcomes between 1st April and 31stMarch, in 2019/2020 (pre-pandemic); 2020/2021 (lockdown period); and 2021/22 (post-lockdown). <h3>Results</h3> Overall, TB was diagnosed in 270/772 patients. In the lockdown period, the median number of in-person clinic appointments fell, with a corresponding rise in virtual reviews that persisted post-lockdown. There was a decrease in the proportion of UK-origin patients diagnosed and increase in South-Asian patients. There was also a change in the source of referral, with an increased contribution from contact tracing, radiology and in-patients during the lockdown period, likely reflecting limited access to healthcare services and a higher rate of significant household exposure. Although overall interval from symptom onset to starting antituberculous therapy (ATT) was unchanged in the lockdown period, time to starting treatment increased for pulmonary TB (PTB) and fell for extrapulmonary TB (EPTB), likely reflecting attribution of symptoms to COVID-19 for PTB and possible cancer for EPTB in virtually assessed patients. Importantly, interval to starting ATT after symptom onset increased in the post lockdown period that is partially explained by delayed patient presentation, likely reflecting incomplete recovery of primary healthcare services. ATT completion rates were highest (97.7%) during the lockdown period, when case-manager support was facilitated by restricted patient mobility, but dropped post-lockdown (86.3%) with more patients lost to follow-up. <h3>Conclusions</h3> Our data provides evidence for changes to TB presentation during the pandemic. Expected delays in PTB diagnosis and treatment were observed during lockdown, however these were attributable to delayed presentation to services. A virtual RATB model, with intensive case-manager support provided effective care. Delayed diagnosis and falling treatment completion rates are observed post-lockdown, supporting prioritisation of recovery from COVID-19 in the TB action plan (2021–26).¹ <h3>Reference</h3> https://www.gov.uk/government/publications/tuberculosis-tb-action-plan-for-england/tuberculosis-tb-action-plan-for-england-2021-to-202