Exploring the impact of the COVID-19 pandemic on the social determinants of tuberculosis in Addis Ababa, Ethiopia: a qualitative study

Tuberculosis (TB) remains a major public health problem in Ethiopia and has been exacerbated by coronavirus 2019 (COVID-19). There is limited qualitative exploration of the impact of COVID-19 on the social determinants of TB and opportunities for TB care during the pandemic. Understanding participants’ insights is important for developing actionable strategies to mitigate the impact of future health crises on TB care. This study explored the impact of COVID-19 on the social determinants of TB in Addis Ababa, Ethiopia. Twenty-four patients with TB and 20 healthcare workers involved in TB care were selected from twenty health centers in Addis Ababa. Participants were recruited using a purposive sampling. Key informants and in-depth interviews were conducted among healthcare workers and patients with TB, respectively. A semi-structured interview guide was used. Interviews were recorded, transcribed verbatim, and translated into English. Thematic analysis was used to identify key themes, and direct quotes of the participants were included. The COVID-19 pandemic has significantly affected social determinants of TB, including access to healthcare, economic stability, food security, social stigma, and awareness. Findings showed that movement and transportation restrictions limited patients’ access to TB care, whereas the reallocation of resources to cope with COVID-19 strained TB programs. Economic instability due to job losses and loss of income prevented patients from being able to afford transportation and food. In addition, increased stigmatization of respiratory diseases during the pandemic discouraged people from seeking care, while public health campaigns focused on COVID-19 diverted attention away from TB awareness efforts. Despite these challenges, participants highlighted the use of digital health technologies and home-based interventions to mitigate disruptions in TB care. This study revealed the impact of COVID-19 on the social determinants of TB, including limited access to healthcare, economic instability, food insecurity, increased social stigma, and inadequate awareness. The findings highlighted the need to address the compounding effects of the pandemic on the social determinants of TB, call for integrated interventions such as psychosocial, financial, and nutritional support programs, and scale up digital technologies to strengthen TB care during the pandemic period.