Trends in tuberculosis care, treatment outcomes, and mortality during the early phase of COVID-19 pandemic in Korea

BACKGROUND: The COVID-19 pandemic disrupted global tuberculosis (TB) control, raising concerns about its impact on diagnosis, treatment outcomes, and latent infection management. Korea's Public-Private Mix (PPM) TB control project integrates private providers into national TB services. This study evaluated early pandemic trends in TB care and prevention within the PPM project. METHODS: Nationwide PPM cohort data from July 2019 to December 2021 were analyzed across five semi-annual periods. Monitoring indicators included diagnostic coverage, treatment success and completion, all-cause death, contact investigation, and initiation of TB preventive treatment (TPT). Trends were assessed using chi-square tests for trend. RESULTS: Diagnostic coverage increased significantly across most modalities (P < 0.001), except phenotypic drug susceptibility testing. Twelve-month treatment completion rate improved overall (P = 0.005), particularly among people < 65 years (P < 0.001) and new cases (P = 0.039). Treatment success rate remained stable (P = 0.123) but declined in those > 65 years (P = 0.030). All-cause death rate increased from 12.2% to 14.9% (P < 0.001), largely due to non-TB-related deaths. Contact investigation coverage peaked in early 2020 and subsequently declined, whereas TPT coverage rose steadily throughout the study period (P < 0.001). CONCLUSION: Despite global disruptions, Korea's PPM project maintained essential TB services during the early pandemic, with improvements in diagnostic testing and TPT uptake. However, increased death rates and declining treatment success among older adults warrant careful interpretation and suggest the need for continued monitoring and tailored support. Ongoing monitoring of TB indicators will be important to understand the longer-term impact of the pandemic on TB care and prevention.