COVID-19 set back drug-resistant TB care in Sierra Leone

Sierra Leone is one of 30 countries with a high burden of tuberculosis, recording an incidence of 286 per 100,000 people in 2023 and an estimated 5,000 missing TB cases each year. Problems in finding and reporting cases of drug-susceptible TB can allow resistant strains to emerge. The COVID-19 pandemic added pressure to an already strained system, and public health researchers sought to measure how those pressures affected people with drug-resistant TB. This study, with corresponding author Sulaiman Lakoh, uses national treatment records to compare outcomes before, during and after the COVID-19 period. By looking at newly identified drug-resistant TB cases across years, the researchers aimed to see whether the pandemic changed who was diagnosed, how treatment began, and whether patients completed care. The work provides a focused look at treatment outcomes in the national drug-resistant TB programme and asks whether the pandemic led to more treatment failures or interrupted care for this vulnerable group.

The team performed a cross-sectional retrospective analysis of newly identified drug-resistant TB cases recorded in the national drug-resistant TB database between January 2017 and December 2022, covering pre-COVID-19, during COVID-19, and post-COVID-19 periods. Data were analysed using STATA. Descriptive statistics summarised demographic and clinical characteristics and treatment outcomes, and logistic regression examined the association between time period and treatment outcomes after adjusting for age, gender, nutritional status, HIV status and treatment regimens. A p-value of <0.05 was used to indicate statistical significance at the 95% confidence level. Of 701 drug-resistant TB patients, 383 (54.6%) were registered before COVID-19, 228 (32.5%) during COVID-19, and 92 (12.8%) after COVID-19. Pre-treatment TB cases fell from 359 (92.5%) in the pre-COVID-19 period to 80 (30.9%) during COVID-19, while new treatment cases rose from 29 (7.5%) to 159 (61.4%) in the COVID-19 period. The share of patients who completed treatment decreased from 74.7% pre-COVID-19 to 63.3% during COVID-19, with a partial rebound to 68.5% post-COVID-19. Overall, successful treatment outcomes were higher before COVID-19 (74.7%) than during it (63.3%); compared with the pre-COVID-19 period, the odds of a successful outcome were 42% lower in the COVID-19 period (OR 0.58, 95% CI 0.42 to 0.82).

The findings show a clear dip in treatment success for drug-resistant TB during the COVID-19 period and a partial recovery afterward. That decline in successful outcomes during the pandemic highlights how disruptions to health services, case finding and the start of treatment can translate into measurable harm for people with drug-resistant infections. The rapid recovery in the post-COVID-19 period suggests that health services can rebound when pressures ease, but the temporary setback indicates vulnerability in the system. The authors conclude that robust mitigation strategies are needed to protect drug-resistant TB management during public health emergencies so that diagnosis, notification and continuous treatment are maintained and so that gains made before a crisis are not lost.