The impact of COVID-19 pandemic in tuberculosis diagnosis in sub-Saharan Africa: data from DREAM program in Mozambique

Background: TB is a global emergency, COVID-19 reversed the trend in TB mortality reduction to 2017 levels. Mozambique is one of the highest-burden countries with 368 new cases per 100.000 population in 2020. Objectives: This analysis aims to evaluate a TB diagnostic service in two Mozambican cities before and during the COVID-19 pandemic. Methods: We reviewed routine activity data from two laboratories in Mozambique (Maputo and Beira) in the period 01/2018- 08/2022. GeneXpert test was prescribed based on clinical suspicion. Data about the number of tests, results, and rifampicin resistance were collected. Results: In the period 3,071 tests were conducted: 391 positive, and 32 rifampicin resistant. The number of positive samples was higher in Beira (20.2% vs 5%, OR 4[3.1-5.2]). In Maputo, we observed a higher percentage of rifampicin-resistant samples (13.2%vs7%, OR 0.5[0.2-1.1]), but the overall prevalence of rifampicin resistance was higher in Beira (14.1%ovs6.6%o, OR 2.1[1.0-4.5]). In 2020 and the first semester of 2021 a reduction in activity was observed, but positivity rates remained stable, with a slight increment starting in 2020. Conclusions: Our data confirm the impact of the COVID-19 pandemic on TB diagnostic services but also highlight possible benefits in terms of diagnostic appropriateness in clinical centers.