Impact of COVID-19 on tuberculosis and HIV health services delivery in Ghana: qualitative evidence from the perspectives of healthcare providers.

Introduction: The COVID-19 burden, coupled with unprecedented control measures including physical distancing, travel bans, and lockdowns in cities, has undoubtedly far-reaching consequences on healthcare services and has affected human immunodeficiency virus (HIV) and tuberculosis (TB) health services in both low- and high-income countries. This study, therefore, explored the perspective of HIV and TB health service providers to better understand how the pandemic impacted health service delivery in Ghana.

Method: This qualitative explorative study was conducted among HIV and TB healthcare providers (n = 30) in six districts of Ghana from March to May 2021 using in-depth interviews. Face-to-face interviews were conducted to explore the challenges faced with HIV and TB diagnosis, treatment, and strategies implemented to mitigate the impact. Participants were also asked to recommend remedial actions. Data were analysed thematically.

Results: The study demonstrated that while patients' access to health facilities and service provision was hindered due to factors such as lockdowns and mandatory wearing of masks, the fear of COVID-19 infection and stigma, repurposing resources for COVID-19 response, and shortage of personal protective equipment and HIV drugs affected TB and HIV health services. However, specific guidelines and measures, including home visits, awareness campaigns, bidirectional COVID-19 and TB testing, and running a staff shift system were implemented to maintain the continuation of routine TB and HIV services during the pandemic. Participants recommended the need to strengthen TB and HIV, as well as COVID-19 diagnostic services by ensuring the availability of logistics and supplies.

Conclusion: This study identified a myriad of factors, ranging from governmental to individual-level factors due to the COVID-19 pandemic, that impeded TB and HIV healthcare services in Ghana. This highlights the need to prioritize routine TB and HIV service delivery, continuous health education, and an uninterrupted supply of drugs and commodities to ensure that TB and HIV services are more resilient against the effects of the ongoing COVID-19 and any future pandemic.