Impact of the COVID-19 pandemic on tuberculosis diagnosis and outcomes among HIV coinfected patients

Background: Tuberculosis (TB) infection remains a leading cause of morbidity and mortality worldwide, particularly among people living with HIV/AIDS (PLWHA), in whom coinfection substantially exacerbates disease severity and worsens clinical outcomes. The COVID-19 pandemic profoundly disrupted healthcare systems globally, reversing years of progress in TB control and disproportionately affecting vulnerable populations. However, real-world evidence on its impact on TB-HIV care remains limited, especially in high-burden settings. Objective: To assess the impact of the COVID-19 pandemic on TB diagnostic performance, testing strategies, and treatment outcomes among HIV-coinfected individuals, and to discuss its broader implications for global TB control.

Methods: A retrospective, descriptive and analytical study was conducted using population-based surveillance data from the TB notification system (TBWeb-SP) of the
Epidemiological Surveillance Group XXIX (GVE-XXIX), São José do Rio Preto region, São Paulo State, Brazil, from 2018 to 2022. All notified TB cases were included, with focused analysis on HIV-positive patients. Variables comprised sociodemographic characteristics, clinical presentation, diagnostic modalities, treatment duration, outcomes, and antiretroviral therapy (ART) use.

Results: Among 1,398 TB cases, 154 (11.0%) were HIV-positive, of whom 147 (95.46%) had confirmed TB-HIV coinfection. The most affected age group was 30–39 years, predominantly male, and pulmonary disease predominated. Cure was achieved in 82 patients (56.16%), while treatment abandonment occurred in 20 (13.69%) and 37 (25.34%) died from non-TB-related causes. During the pandemic period (2020–2021), substantial reductions were observed in bacteriological confirmation, culture, histopathological examination, and imaging studies, leading to fewer confirmed diagnoses and lower treatment success rates. A partial recovery was documented in 2022, with a 60% increase in Rapid Molecular Testing (Xpert MTB/RIF) compared with 2021. These disruptions resulted in underdiagnosis, delayed treatment initiation, and compromised therapeutic outcomes, mirroring trends reported across multiple high-burden countries.

Conclusion: The COVID-19 pandemic significantly undermined TB-HIV care by impairing diagnostic capacity and treatment effectiveness, reinforcing global concerns regarding setbacks in TB elimination targets. Strengthening resilient, integrated TB-HIV health systems, expanding access to rapid molecular diagnostics, and prioritizing active case finding are critical strategies to mitigate future health system shocks and sustain progress toward global TB control.