One year on - the long-term impact of COVID-19 pandemic and government restrictions on the health-seeking behaviour, financial security and mental health of TB survivors.

BACKGROUND: People with tuberculosis (TB) may face long-term physical and psycho-social-economic disability related to TB treatment. The Corona Virus Disease 2019 (COVID-19) pandemic and government restrictions disrupted health care services. We describe health-seeking behaviour, perceived financial impact, and the mental health of TB survivors one year after the COVID-19 pandemic. We further explore factors associated with the perceived impact of COVID-19 and government restrictions on health-seeking behaviour.

METHODS: This is a cross-sectional study nested in an ongoing observational TB Sequel cohort study. Adults (≥ 18yrs) who had completed treatment for drug-susceptible pulmonary TB in South Africa, the Gambia, and Mozambique before the start of the COVID-19 pandemic, completed a COVID-19 questionnaire which included the WHO tool for Behavioural Insights on COVID-19, the Kessler Psychological Distress Scale (K10) and Medical Outcomes Short Form Survey (SF-36) for health-related quality of life. Questionnaires were administered during scheduled TB Sequel follow-up study visits between 04/2021 and 10/2021. We used publicly available data on the number of COVID-19 cases and the start and end date of each wave to define country-specific COVID-19 "in-wave" and "out-of-wave" phases. We compared psycho-social and economic measures reported during these phases. In addition, we explored factors associated with poor health-seeking behaviour (comprised of moderate or serious impact) using logistic regression.

RESULTS: Four hundred eighty seven TB survivors (69% male, median age 33 years IQR 25-42, median time since TB treatment completion 16 months IQR 13-27) completed the COVID-19 questionnaire. About a quarter of TB survivors reported that their financial status (n = 117; 24%) or their health-seeking behaviour for any health condition (n = 128; 26%) had been seriously impacted by COVID-19 and the governments' response. A third of patients (30.4%) reported using coping strategies. Logistic regression indicated that males, living with HIV and being on antiretroviral treatment (ART), being impacted financially during COVID-19, and experiencing social changes, were associated with poor health-seeking behaviour.

CONCLUSION: Governments' response to COVID-19 affected TB survivors' healthcare-seeking behaviour, financial status and mental health. The long-term adverse effects on health-seeking behaviour are important for TB survivors who are at increased risk for recurrent disease and long-term disability in the first two years after treatment completion.

TRIAL REGISTRATION: Clinical trial number: not applicable.