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TUBERCULOSIS SERVICES DURING THE COVID-19 PANDEMIC: A QUALITATIVE STUDY ON THE
IMPACT OF COVID-19 AND PRACTICES FOR CONTINUED SERVICES DELIVERY IN ESWATINI.

Victor Williams, Alinda G Vos-Seda, Marianne Calnan, Lindiwe Mdluli-Dlamini,
Samson Haumba, Diederick E Grobbee, Kerstin Klipstein-Grobusch, Kennedy Otwombe
Public health in practice. 2023 December
OBJECTIVES: To describe the impact of the COVID-19 pandemic on tuberculosis
services and the different approaches healthcare workers adopted to ensure
continued tuberculosis service delivery in Eswatini.

STUDY DESIGN: This is a qualitative study with a cross-sectional design.

METHODS: Thirteen nurses and 9 doctors who provide tuberculosis care from 10
health facilities participated in an in-depth interview to describe how the
COVID-19 pandemic affected tuberculosis services and the approaches adopted to
ensure continued patient care. Twenty in-person and 2 telephone interviews were
conducted. The participating facilities were selected based on a ranking
criterion of the number of patients seen. Data were analyzed using thematic
content analysis. NVivo 12 software was used for qualitative analysis, and the
Consolidated Criteria guided the study for Reporting Qualitative research
(COREQ).

RESULTS: Two major themes emerged: COVID-19 impacted services delivery and
access; and best practices that ensured healthcare services delivery. Six
sub-themes describe how COVID-19 impacted services: all attention focused on
COVID-19; COVID worsened the health system challenges; COVID hindered patients
from accessing care; patients defaulted due to the lockdown; COVID impacted the
quality of care and increased the risk of infection among healthcare workers.
Five sub-themes describe best practices that ensure continued service delivery:
Home-based care, Patient support, Patient Education, Integrated Services, and
Staff rotation.

CONCLUSION: While various strategies were adopted globally to mitigate the
impact of the COVID-19 pandemic, these strategies need contextualization to be
effective and sustainably incorporated into routine care to ensure continuity of
and access to TB and other healthcare services.



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