How COVID-19 Strained Tanzania’s Tuberculosis Care (and What Helped)

When COVID-19 arrived, tuberculosis (TB) services in Tanzania faced sudden new pressures. A team led by Doreen Pamba set out to document what happened during the pandemic’s first year (March 2020–February 2021) and how health workers responded. The researchers conducted a qualitative descriptive study that drew on in-depth interviews and group discussions carried out in July 2022. They purposively selected 37 TB treatment facilities across seven regions that had high TB case notifications in 2019 and that provided both TB and COVID-19 services during the first year of the pandemic. From those facilities the study team spoke with 58 healthcare workers (HCWs) and 55 community health workers (CHWs). The goal was to describe COVID-19’s effects on TB commodity supply, the care cascade and active case finding, and to capture the practical responses taken by HCWs and CHWs when services and patients were disrupted. The study focuses on frontline experiences, aiming to show what problems emerged and which adaptations helped keep treatment and case-finding going.

The study combined 25 in-depth interviews and 10 focus group discussions to gather frontline perspectives. Participants reported a range of supply and service problems: unusual stockouts and delayed receipt of GeneXpert cartridges and sputum containers limited laboratory testing capacity. Clinic attendance fell as people hesitated to be screened, provide sputum samples or participate in contact tracing because they feared catching COVID-19 or being diagnosed and quarantined. To manage these gaps, staff adopted several pragmatic measures. HCWs used alternative containers for sputum sample collection and optimized limited GeneXpert cartridges by prioritizing GeneXpert testing for TB risk groups. Where GeneXpert was constrained they relied more on microscopy and chest X-ray, and sometimes used a sputum pooling method to stretch laboratory resources. Drug refill schedules were extended to reduce clinic visits. CHWs shifted to mobile communication for client tracing and focused household visits on people at higher TB risk. These changes helped maintain core services despite supply and demand shocks.

The findings show that COVID-19 disrupted both the availability of TB commodities and people’s willingness to seek TB care, but also that frontline teams developed adaptive practices that supported resilience. Measures such as extending drug refill schedules (multi-month drug refills), prioritizing GeneXpert use for high-risk groups, using alternative sputum containers, and employing microscopy, chest X-ray and sputum pooling provided stopgap solutions that kept diagnosis and treatment moving. The study highlights that these practical adaptations offer important lessons for strengthening TB service delivery beyond the pandemic, but it cautions that their effectiveness and sustainability are not yet proven. The authors note strengths including triangulation of data collection and researcher perspectives, but also acknowledge limitations: retrospective interviews may introduce recall bias and focusing on high-COVID-19 regions may limit how well the findings transfer to areas less affected by COVID-19. They recommend prospective studies to assess long-term impact and suggest National Tuberculosis Programs consider adapting successful practices to local contexts with appropriate evaluation.