Patient and provider perceptions of the impact of COVID-19 on tuberculosis healthcare access and delivery: an interpretive description study of the complexities of a pandemic within a pandemic in Alberta, Canada

Introduction We aimed to explore patient and provider perspectives of the impact of the COVID-19 pandemic on tuberculosis healthcare access and service delivery. Methods We used interpretive description, a qualitative approach with the end-goal of informing decisions and actions in clinical practice. Levesque et al ’s ‘Conceptual framework of access to health care’ informed the development of our interview guides. Interviews were conducted virtually and confidentially transcribed verbatim. Data generation and analysis occurred concurrently. Analysis was informed by Braun and Clarke’s six phases of reflexive thematic analysis. Strategies to enhance rigour and trustworthiness of the findings were used. Results We completed 15 interviews: 6 with patients and 9 with providers. Three key themes were generated: (1) diagnostic hurdles created delay; (2) hybrid services promote health equity; and (3) navigating the complexities of a pandemic within a pandemic. Diagnosing tuberculosis was challenging even prior to the pandemic since some providers lacked experience and familiarity with the condition. The diagnostic process was further complicated with the onset of the COVID-19 pandemic. However, COVID-19 also introduced streamlined virtual care for patients which was convenient and improved access but was not viewed as being equivalent to in-person care. The intersection of the COVID-19 and tuberculosis pandemics created competition for limited resources while highlighting learnings that may positively impact future tuberculosis care. Conclusions Our findings can inform health system leadership about how the COVID-19 pandemic impacted care of other public health threats like tuberculosis, helping to prepare more effectively and equitably for future challenges.