Barriers to treatment adherence for female Tuberculosis (TB) patients during the COVID-19 pandemic: Qualitative evidence from front-line TB interventions in Bengaluru City, India.

Background: Available evidence shows that India's ongoing COVID-19 pandemic response has adversely affected the national tuberculosis elimination program.

Objectives: The study attempted to understand the barriers to successful treatment adherence for female tuberculosis (TB) patients due to disruptions caused by the pandemic.

Methods: The study draws on qualitative in-depth interviews conducted with patients and TB health visitors from Bengaluru city before and during the pandemic period using a grounded theory approach.

Results: While TB has the potential to push female patients who worked in informal arrangements to joblessness and poverty, the pandemic situation has exacerbated these vulnerabilities. The pandemic situation slowed down or suspended vital frontline interventions such as active case finding, distribution of medicine, follow-up of sputum examination, monitoring of medicine intake, and patient support measures.

Conclusion: The pandemic-induced barriers to treatment adherence for the vulnerable TB patients can lead to adverse treatment outcomes including disease relapse and drug resistance. It is hence suggested that there is an urgent need for recasting the frontline TB interventions in India in the context of the pandemic in order to achieve the goal of TB elimination.