There was concern that the COVID-19 pandemic would adversely affect TB and HIV programme services in Kenya. We set up real-time monthly surveillance of TB and HIV activities in 18 health facilities in Nairobi so that interventions could be implemented to counteract anticipated declining trends. Aggregate data were collected and reported monthly to programme heads during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data collected during the pre-COVID period (March 2019–February 2020). During the COVID-19 period, there was an overall decrease in people with presumptive pulmonary TB (31.2%), diagnosed and registered with TB (28.0%) and in those tested for HIV (50.5%). Interventions to improve TB case detection and HIV testing were implemented from August 2020 and were associated with improvements in all parameters during the second six months of the COVID-19 period. During the COVID-19 period, there were small increases in TB treatment success (65.0% to 67.0%) and referral of HIV-positive persons to antiretroviral therapy (91.2% to 92.9%): this was more apparent in the second six months after interventions were implemented. Programmatic interventions were associated with improved case detection and treatment outcomes during the COVID-19 period, suggesting that monthly real-time surveillance is useful during unprecedented events.

SUMMARY: BACKGROUND: We examined the feasibility of assessing and referring adults successfully completing TB treatment for comorbidities, risk determinants and disability in health facilities in Kenya, Uganda, Zambia and Zimbabwe. METHODS: This was a cross-sectional study within national TB programmes. RESULTS: Health workers assessed 1,063 patients (78% of eligible) in a median of 22 min [IQR 16–35] and found it useful and feasible to accomplish in addition to other responsibilities. For comorbidities, 476 (44%) had HIV co-infection, 172 (16%) had high blood pressure (newly detected in 124), 43 (4%) had mental health disorders (newly detected in 33) and 36 (3%) had diabetes mellitus. The most common risk determinants were ‘probable alcohol dependence’ (15%) and malnutrition (14%). Disability, defined as walking <400 m in 6 min, was found in 151/882 (17%). Overall, 763 (72%) patients had at least one comorbidity, risk determinant and/or disability. At least two-thirds of eligible patients were referred for care, although 80% of those with disability needed referral outside their original health facility. CONCLUSIONS: Seven in 10 patients completing TB treatment had at least one comorbidity, risk determinant and/or disability. This emphasises the need for offering early patient-centred care, including pulmonary rehabilitation, to improve quality of life, reduce TB recurrence and increase long-term survival.

Real-time operational research can be defined as research on strategies or interventions to assess if they are feasible, working as planned, scalable and effective. The research involves primary data collection, periodic analysis during the conduct of the study and dissemination of the findings to policy makers for timely action. This paper aims to illustrate the use of real-time operational research and discuss how to make it happen. Four case studies are presented from the field of tuberculosis. These include (i) mis-registration of recurrent tuberculosis in Malawi; (ii) HIV testing and adjunctive cotrimoxazole to reduce mortality in TB patients in Malawi; (iii) screening TB patients for diabetes mellitus in India; and (iv) mitigating the impact of COVID-19 on TB case detection in capital cities in Kenya, Malawi and Zimbabwe. The important ingredients of real-time operational research are sound ethics; relevant research; adherence to international standards of conducting and reporting on research; consideration of comparison groups; timely data collection; dissemination to key stakeholders; capacity building; and funding. Operational research can improve the delivery of established health interventions and ensure the deployment of new interventions as they become available, irrespective of diseases. This is particularly important when public health emergencies, including pandemics, threaten health services.

Background Tuberculosis (TB) remains a public health concern despite the massive global efforts towards ending TB. Kenya is among the high burdened countries globally with the TB prevention and care efforts hampered by poor health systems, resource limitations and other socio-political contexts that inform policy and implementation. Notably, TB cases are much higher in men than women, and therefore, the political economy analysis study provides in-depth contexts and understanding of the gender gaps to access and successful treatment for TB infection. Methods The Political Economy Analysis (PEA) adopted a qualitative in-depth approach that targeted 16 Key Informant Interviews (KIIs). The Key Informant Interviews (KIIs) were distributed among government entities, academia, non-state actors, and community TB groups. Results The themes identified were mapped onto the applied PEA analysis framework domains. The contextual and institutional issues included gender concerns related to the disconnect between TB policies and gender inclusion aspects, such as low prioritization for TB programs, limited use of evidence to inform decisions and poor health system structures. The broad barriers influencing the social contexts for TB programs were social stigma and cultural norms such as traditional interventions that negatively impact health-seeking behaviors. The themes around the economic situation were poverty and unemployment, food insecurity, and malnutrition. The political context centered around the systemic and governance gaps in the health system from the national and devolved health functions. Conclusion Overall, broad contextual factors identified from the political economy analysis widens the disparity in targeted gender efforts toward men. Following the development of effective TB policies and strategies, it is important to have well-planned gendered responsive interventions with a clear implementation plan and monitoring system to enhance access to TB prevention and care. Strength and limitations The study provides insights into the political, economic, and social contexts influencing TB prevention and care efforts. Additionally, to the best of our knowledge, this will be the first PEA to evaluate the TB program from a gendered perspective. As a limitation, the study is missing the voices and lived experiences of men leaving with TB as this was not part of the study scope. As such, we do not have their perspectives as they may better articulate some barriers faced with access and uptake of TB prevention and management programs.