Bidirectional screening and testing for TB and COVID-19 among outpatient department attendants: Outcome of an initial intervention in Ghana

Abstract

Background: Tuberculosis (TB) remains a major public health threat in Ghana. The impact of COVID-19 resulted in a 15% decline of TB case notification in 2020 compared to 2019. To mitigate the impact on TB services, the Ghana National Tuberculosis Programme (NTP) introduced the bidirectional screening and testing for TB and COVID-19 in 2021. Objective: To evaluate the yield of bidirectional screening and testing for TB and COVID-19 among facility attendants in the Greater Accra region. Method: We used secondary data obtained from the initial implementation stage of the bidirectional testing for TB and COVID-19 among COVID-19 and/or TB presumed cases in five health facilities in the Greater Accra Region from January to March 2021. Results: A total of 208 presumed cases were identified: 113 were tested for COVID-19 only, and 94 were tested for both TB and COVID-19, 1 was tested for TB only. Among presumed cases tested for COVID-19, 9.7% (95% CI, 5.6%-13.7%) were tested positive. Whilst among the total presumed tested for TB, 13.7% (95% CI, 6.8%-20.6%) were confirmed to have TB. Among the total 94 presumed cases tested for both TB and COVID-19, 11.7% (95% CI, 5.2%-18.2%) were confirmed to have TB and 13.8% (95% CI, 6.9%-20.8%) participants were COVID-19 positive and one participant (1.1%) had both COVID-19 and TB. Conclusion: Bidirectional screening and testing for COVID-19 and TB among facility attendants yielded a higher proportion of TB and COVID-19 cases. Bidirectional screening and testing for TB and COVID-19 shows significant potential for improving overall case detection for the two diseases. The bidirectional screening and testing could be applicable to address similar respiratory epidemic in the future that might have a masking effect for TB case detection.