Impact of the COVID-19 pandemic on tuberculosis program performance in Alberta, Canada: a population-based evaluation.

Abstract

Background: The COVID-19 pandemic caused major disruptions to essential tuberculosis (TB) services globally. We evaluated the performance of the TB program in Alberta, Canada, in 2 periods - before and during the pandemic - to estimate the impact of those disruptions.

Methods: We applied 10 program performance indicators and their related targets and compared them by period. The performance indicators included a measure of decline in the age- and sex-adjusted incidence by population group, the proportion of recently arrived immigrants screened on time, and 5 case management and 3 close contact management indicators. We measured performance targets by time period and clinic type - outpatient versus virtual. We used interrupted time series analysis to estimate the impact of the COVID-19 pandemic response on timeliness of immigrant screening.

Results: Since 2009, the rate of disease has declined in the Canadian-born but not the foreign-born population. However, the rate of disease by population group was not different prepandemic versus during the pandemic. Program performance was not negatively affected by the pandemic in general, but there was a large reduction in immigration and, in turn, the number of immigrants referred for screening (37.6%) and contacts identified for assessment (71.8%) during the pandemic, associated with improvements to the proportion of referrals assessed (91.7% v. 96.6%, relative risk [RR] 0.949, 95% confidence interval [CI] 0.936-0.962); contacts assessed (81.7% v. 90.0%, RR 0.908, 95% CI 0.875-0.943), and contacts completing treatment of infection (90.4% v. 97.1%, RR 0.931, 95% CI 0.886-0.979). Among patients with TB disease, monitoring of treatment response was suboptimal, whereas other targets were met or nearly met. Virtual clinic performance tended to be worse during the pandemic than the outpatient clinics.

Interpretation: COVID-19-related disruptions were not as substantial in the Alberta TB program as elsewhere, likely because of its centralized operational model and protection of its staff from secondment. However, no progress has been made toward reducing TB incidence. Better resourcing of prevention activity and a more responsive information system should be considered.