Impact of the COVID-19 Pandemic on Quality of Tuberculosis Care in Private Facilities in Bandung, Indonesia: A Comparison of Cross-Sectional, Standardized Patients Studies

Introduction: Indonesia has the second highest incidence of tuberculosis (TB) in the world. While 74% of people with TB in Indonesia first accessed the private health sector when seeking care for their TB symptoms, only 18% of TB notifications originate in the private sector. Little is known about the impact of the COVID-19 pandemic on the private sector. Using unannounced standardized patient (SP) visits to private providers, we aimed to measure quality of TB care during the COVID-19 pandemic.Methods: A cross-sectional study was conducted using SPs in Bandung City, West Java, Indonesia. Ten SPs completed 292 visits with private providers between 9 July 2021 and 21 January 2022, wherein SPs presented a presumptive TB case. Results were compared to SP surveys conducted in the same geographical area before the onset of COVID-19.Results: Overall, 35% (95% CI: 29·2–40·4%) of visits were managed correctly according to national TB guidelines. There were no significant differences in the clinical management of presumptive TB patients before and during the COVID-19 pandemic, apart from an increase in temperature checks (aOR: 7·74, 95% CI: 2·78–21·5, p<0·001) and a decrease in throat examinations (aOR 0·15, 95% CI: 0·06–0·41, p=0·003) conducted during the pandemic.Conclusion: Results indicate that providers successfully identify TB in their patients yet do not manage them according to national guidelines. As TB notifications have declined in Indonesia due to the COVID-19 pandemic, there remains an urgent need to increase private provider engagement in Indonesia and improve quality of care.Funding: Bill & Melinda Gates Foundation.Declaration of Interest: The authors have no financial or industry-related conflicts. MP serves as an advisor to non- profits, namely the World Health Organization, Stop TB Partnership, Bill & Melinda Gates Foundation, and Foundation for Innovative New Diagnostics.Ethical Approval: This study was approved by the McGill University Health Centre (MUHC) Research Ethics Board (REB) (COVID BMGF / 2021-7197), Georgetown University (Georgetown-MedStar IRB System STUDY00003422), and the Research Ethics Committee of Universitas Padjadjaran, Bandung, Indonesia (No.166/UN6.KEP/EC/2021). Informed consent was waived to ensure that providers would undergo their normal routine, thus ensuring the validity of the data collected for this study.