Marti, MarianaMarianaMartiZürcher, KathrinKathrinZürcherEnane, Leslie ALeslie AEnaneDiero, LameckLameckDieroMarcy, OlivierOlivierMarcyTiendrebeogo, ThierryThierryTiendrebeogoYotebieng, MarcelMarcelYotebiengTwizere, ChristelleChristelleTwizereKhusuwan, SuwimonSuwimonKhusuwanYunihastuti, EvyEvyYunihastutiReubenson, GaryGaryReubensonShah, N SaritaN SaritaShahEgger, MatthiasMatthiasEgger0000-0001-7462-5132Ballif, MarieMarieBallif0000-0003-3133-3011Fenner, LukasLukasFenner0000-0003-3309-48352024-10-112024-10-112022-10https://boris-portal.unibe.ch/handle/20.500.12422/88401INTRODUCTION COVID-19 stretched healthcare systems to their limits, particularly in settings with a pre-existing high burden of infectious diseases, including HIV and tuberculosis (TB). We studied the impact of COVID-19 on TB services at antiretroviral therapy (ART) clinics in low- and middle-income countries. METHODS We surveyed ART clinics providing TB services in the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in Africa and the Asia-Pacific until July 2021 (TB diagnoses until the end of 2021). We collected site-level data using standardized questionnaires. RESULTS Of 46 participating ART clinics, 32 (70%) were in Africa and 14 (30%) in the Asia-Pacific; 52% provided tertiary care. Most clinics (85%) reported disrupted routine HIV care services during the pandemic, both in Africa (84%) and the Asia-Pacific (86%). The most frequently reported impacts were on staff (52%) and resource shortages (37%; protective clothing, face masks and disinfectants). Restrictions in TB health services were observed in 12 clinics (26%), mainly reduced access to TB diagnosis and postponed follow-up visits (6/12, 50% each), and restrictions in TB laboratory services (22%). Restrictions of TB services were addressed by dispensing TB drugs for longer periods than usual (7/12, 58%), providing telehealth services (3/12, 25%) and with changes in directly observed therapy (DOT) (e.g. virtual DOT, 3/12). The number of TB diagnoses at participating clinics decreased by 21% in 2020 compared to 2019; the decline was more pronounced in tertiary than primary/secondary clinics (24% vs. 12%) and in sites from the Asia-Pacific compared to Africa (46% vs. 14%). In 2021, TB diagnoses continued to decline in Africa (-8%) but not in the Asia-Pacific (+62%) compared to 2020. During the pandemic, new infection control measures were introduced or intensified at the clinics, including wearing face masks, hand sanitation and patient triage. CONCLUSIONS The COVID-19 pandemic led to staff shortages, reduced access to TB care and delays in follow-up visits for people with TB across IeDEA sites in Africa and the Asia-Pacific. Increased efforts are needed to restore and secure ongoing access to essential TB services in these contexts.enCOVID-19 HIV clinic antiretroviral therapy differentiated service delivery low- and middle-income countries tuberculosis600 - Technology::610 - Medicine & health300 - Social sciences, sociology & anthropology::360 - Social problems & social servicesarticle10.48350/1741843628560210.1002/jia2.26018