Tuberculosis (TB) is still a major public health concern, despite the availability of preventative and curative therapies. Significant progress has been made in the past decade towards its control. However, the emergence of the novel coronavirus disease 2019 (COVID-19) has disrupted numerous essential health services, including those for TB. This scoping review maps the available evidence on TB services at the primary healthcare (PHC) level during the COVID-19 period. A comprehensive literature search was conducted in PubMed, Web of Science, Medline OVID, Medline EBSCO, and Scopus. A total of 820 articles were retrieved from the databases and 21 met the eligibility criteria and were used for data extraction. The emerging themes were the effect of the COVID-19 pandemic on TB services, patient and provider experiences, recommendations for TB services during the COVID-19 period, and the implementation of the recommendations. The review found that the mitigation strategies, as well as fear and stigma experienced at the start of the COVID-19 pandemic may have led to TB cases potentially going undetected, which may threaten TB treatment outcomes. Therefore, efforts must be directed at finding these missing cases and ensuring that PHC facilities are equipped to adequately diagnose and treat them.

We assessed the impact of the pandemic on TB diagnostics at primary healthcare clinics (PHCs) during the different stages of COVID-19 in eThekwini district, South Africa. Data from the District Health Information System (DHIS) were used to conduct an interrupted time series analysis that assessed the changes in TB investigations and confirmed TB cases during four pandemic periods: lockdown and the subsequent three peaks of infection compared to the two years prior (2018–2022). The initial lockdown resulted in − 45% (95% CI − 55 to − 31) and − 40% (95% CI − 59 to − 28) immediate declines in TB investigations and confirmed cases, respectively. Both indicators showed substantial recovery in the months after the first wave (p < 0.05). However, while TB investigations sustained smaller declines throughout the pandemic, they rebounded and surpassed pre-COVID-19 levels by the end of the investigation period. On the other hand, confirmed cases experienced reductions that persisted until the end of the investigation period. TB diagnostic services at PHCs were considerably disrupted by COVID-19, with the confirmation of cases being the most adversely affected throughout the pandemic. The reasons for these persistent declines in TB detection must be determined to inform the development of sustainable diagnostic systems that are capable of withstanding future pandemics.

Background: Sexually transmitted infections (STIs) are a major global healthcare burden, disproportionately affecting women. Self-sampling interventions for diagnostic purposes have the potential to improve STI healthcare management and expand STI services. However, there is currently no published evidence of the global use of self-sampling interventions to diagnose STIs in women. The main aim of this scoping review was to map evidence on the use of self-sampling interventions to diagnose STIs in women. Methodology: The methodology of this scoping review was guided by Arksey and O’Malley and Levac. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Medline (EBSCO), ProQuest, and Cochrane. For grey literature, a search was conducted in Open Grey, World Health Organization, Google, and conference proceedings and dissertations. All search results were screened and assessed for eligibility. Thereafter data from eligible studies was extracted and analysed. The quality of these studies was appraised using the Mixed Methods Appraisal Tool 2018 version. Results: A total of 770 articles were retrieved from databases and grey literature sources. A total of 44 studies were eligible for data extraction following title, abstract and full-text screening. Of the included studies, 63% presented evidence of research conducted in high-income countries and 37% presented evidence in low- and middle-income countries. Studies presented evidence on the following: feasibility of self-sampling in remote areas; acceptance and ease of use of self-sampling interventions; types of self-sampled specimens; pooled samples for diagnosing STIs; laboratory diagnostic assays for STI using self-sampled specimens; and self-testing of self-sampled specimens. Conclusions: Self-sampling interventions are feasible and easy to use and, therefore, can improve STI management and treatment in women across various age groups and various access levels to good-quality healthcare. Despite this, there is a lack of evidence of self-sampling interventions designed according to user preferences. We recommend studies to collaborate with women to co-develop user-friendly self-sampling interventions to diagnose STIs in women.

Background Improving geographic access can aid in managing tuberculosis (TB) by enabling early diagnosis and treatment initiation. Although geospatial techniques have been used to map the transmission patterns of drug-resistant TB in South Africa, fewer studies have investigated the accessibility of TB diagnostic services. This study evaluated the accessibility of TB diagnostic services and disease distribution in the eThekwini district of South Africa. Methods In this cross-sectional study, population data for 2021 were disaggregated into smaller analysis units and then re-aggregated through the dasymetric mapping technique. Data on notified TB patients, including Global Positioning System coordinates of clinics, were obtained from the District of Health Information System, exported to ArcGIS 10.8.2 and used to calculate distances to the nearest clinics and hospitals. Results 92% of the population (3 730 494 people) in eThekwini could access TB diagnostic services within 5 km. Patients travelled an average distance of 4.7 km (range: 0.1–26.9 km). TB diagnostic services were highly accessible in the Northern and Central regions and moderately accessible in the predominately rural Western and Southern regions. The smallest population of eThekwini resides in rural areas; however, 40.7% of its residents live >5 km from a diagnosing facility, with patients in the South having to travel up to 44.5 km. TB incidence was higher in the predominately rural West and South regions compared with the Central and North regions which are mainly comprised of urban and suburban areas. Our findings also showed that 98.4% of the clinics in eThekwini were located within 30 km of a hospital at an average distance of 9.6 km within the district. However, the distribution of these hospitals does not demonstrate equitable access as the majority are located within the Central region, and fewer are found in the other three regions of eThekwini. Conclusions Addressing the disparities in access to TB diagnostic services is required in the eThekwini district. Leveraging the existing mobile health clinics can assist with this, particularly, in rural areas with inadequate access. Additionally, active-case finding should be intensified in these regions since they had a higher TB burden per population. Prioritising interventions in these areas is crucial for reducing the impact of the disease on affected communities.

BackgroundUninterrupted delivery of tuberculosis (TB) diagnostic services is paramount, since early diagnosis allows for timeous treatment which improves treatment outcomes, reduces the period of infectiousness and limits the development of antibiotic resistant strains of TB. In 2020, the urgency of the public health response to the COVID-19 pandemic supposedly strained many existing public health initiatives. We propose a scoping review to map the evidence of the impact of the COVID-19 pandemic on TB diagnostic services at primary healthcare (PHC) level. Method and AnalysisThis scoping review was guided by the Arksey and O’Malley framework. We will search the databases: PubMed, Web of Science, MEDLINE Ovid, Medline EBSCO, PsycInfo, CINAHL and Scopus. We will also search for reports from national health websites and the World Health Organization (WHO). Two independent reviewers will screen titles, abstracts and full texts of retrieved articles. The chosen articles will be represented in a data charting table. We will conduct a content thematic analysis using NVivo 10 software to extract relevant themes from the included articles. Findings will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Review (PRISMA-ScR). We will assess the quality of the included articles using the mixed methods assessment tool (MMAT). DiscussionWe anticipate that this scoping review will reveal the extent to which TB diagnostic services have been either maintained or disrupted by the COVID-19 pandemic. This information will direct future research, and reveal barriers and enablers for TB diagnostic services during a pandemic.

Introduction: The COVID-19 pandemic has greatly impacted TB diagnostic services in high TB burden settings. This has caused cases to go undetected and increased the number of TB deaths in 2020. Renewed efforts to improve the resilience of TB services during pandemics are required. Therefore, the current study aims to propose a novel approach for conducting TB diagnostic services in high burden settings during the pandemic. Methods/Design: The proposed study will be conducted in three phases. During the first phase, a geospatial analysis to assess the geographic accessibility of TB diagnostic services will be conducted. In the second phase, the effect of COVID-19 on TB diagnostic services will be determined using an interrupted time series analysis. During the third phase, the barriers and enablers of TB diagnostic services will be explored using patient interviews and a vertical audit. The fourth phase of the study will be guided by the outcomes of the previous three phases where a nominal group technique with key stakeholders will be conducted to propose a novel means for conducting TB diagnostic services during the pandemic. The data of the study will be analyzed using the latest version of ArcGIS, Stata software. Discussion: The study has received full ethical approval from ethics committees. The results together with input from relevant TB stakeholders will be used to develop a new approach to conducting TB diagnostic services at Primary healthcare clinics.