From Progress to Disruption: Unveiling the Hidden Impact of COVID-19 on Tuberculosis Indicators in India

From Progress to Disruption: Unveiling the Hidden Impact of COVID-19 on Tuberculosis Indicators in India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article From Progress to Disruption: Unveiling the Hidden Impact of COVID-19 on Tuberculosis Indicators in India Pravin Kumar Singh, Abdul Nasir Khan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7495327/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background To assess the impact of the COVID-19 pandemic on key TB indicators in India by comparing TB notification performance before and during the pandemic, and to inform strategies for integrating TB services into emergency preparedness and strengthening health system resilience. Methods This study analysed 13 critical TB indicators, such as incidence, case notifications, drug resistance, and TB-related mortality, using data from the India TB Report and WHO estimates. An interrupted time-series analysis and linear generalised estimating equations were conducted to evaluate the impact of COVID-19 on TB trends by comparing the pre-pandemic period (2000–2019) with the pandemic period (2020–2023), capturing immediate disruptions and long-term changes in public primary healthcare indicators. Results The study observed substantial disruption in TB-related notifications during the pandemic, with the most pronounced impact in 2020. Though notifications gradually improved, most remained below pre-pandemic levels by 2023. Significant reductions were noted in TB incidence (up to 18.6%), total TB cases (up to 53%), and paediatric TB (up to 45%). Notifications of drug-resistant forms of RR-TB and MDR/RR-TB declined by up to 36.6% and 34.2%, respectively. Post-pandemic increases were seen in TB-HIV co-infection, extrapulmonary TB, and rifampicin-resistant TB (up to 34.6%). TB-related mortality surged, with all forms of TB deaths rising by 85.6% and HIV-associated TB deaths increasing by nearly 97% in 2020 alone. Conclusions COVID-19 sharply disrupted TB notifications in India. Despite partial recovery, indicators remain below pre-pandemic levels. Strengthening TB programs and building resilient health systems is vital to ensure continuity of care during health emergencies. Tuberculosis (TB) COVID-19 pandemic Interrupted Time-Series Analysis Health service disruption TB trends Figures Figure 1 Figure 2 Introduction Tuberculosis (TB) remains a critical public health concern in India, which continues to bear the world’s highest burden of the disease. Despite decades of targeted interventions, TB accounted for approximately 28% of the global incidence in 2019, highlighting persistent gaps in prevention, detection, and care delivery. 1 Since the early 2000s, India has undertaken extensive efforts to strengthen TB surveillance and notification through the Revised National Tuberculosis Control Programme (RNTCP), later rebranded as the National TB Elimination Programme (NTEP). These efforts, supported by the introduction of digital reporting systems (Nikshay), public-private mix models, and expanded diagnostic capacity, have led to substantial improvements in the notification of all TB cases, including bacteriologically confirmed pulmonary TB, paediatric TB, extrapulmonary TB, and drug-resistant forms such as rifampicin-resistant (RR-TB) and multidrug-resistant TB (MDR-TB). 2 Between 2000 and 2019, India implemented several strategic health system interventions aimed at improving TB detection, notification, and treatment outcomes. During this period, the estimated TB incidence showed a slow but steady decline, reflecting the impact of programmatic efforts under the RNTCP, now renamed the NTEP. 1 , 2 Notification of all TB cases increased substantially from under 1 million in the early 2000s to over 2.4 million by 2019 owing to the scale-up of mandatory notification policies, improved reporting from the private sector, and digital surveillance through the Nikshay portal. 2 Bacteriologically confirmed pulmonary TB cases steadily increased as diagnostic capacity expanded, including the deployment of CBNAAT and TrueNat platforms. 2 Paediatric TB notifications also improved due to enhanced training and diagnostic outreach, though underreporting remained a challenge. Extrapulmonary TB maintained a consistent share of reported cases, around 15–20%, supported by better clinical awareness and guidelines. 1 TB-HIV co-infection management improved through intensified testing and ART scale-up, which helped reduce co-infection rates and mortality over time 1 . India also made notable progress in drug-resistant TB management. The number of MDR/RR-TB patients detected rose significantly, from fewer than 10,000 in the early 2010s to over 60,000 by 2019. 2 The proportion of rifampicin-resistant TB among notified pulmonary cases gradually stabilised, supported by the nationwide rollout of universal drug susceptibility testing. 1 Household contact tracing and preventive therapy initiatives were introduced and expanded, though coverage remained below targets. 1 TB-related mortality declined gradually during this period. WHO estimates indicate that TB deaths (all forms) fell due to expanded treatment access and the integration of TB and HIV services. However, the burden remained high, with nearly 450,000 deaths annually by 2019 (excluding HIV-positive individuals), and around 12,000–15,000 annual deaths among PLHIV with TB. 1 Prior to the COVID-19 pandemic, India had made significant strides under the National Strategic Plan for TB Elimination (2017–2025) and the RNTCP, aligning with the targets of the WHO’s End TB Strategy. The advent of the COVID-19 pandemic in early 2020 caused unprecedented disruptions to health systems worldwide. In India, nationwide lockdowns, travel restrictions, and the diversion of health resources to the pandemic response delayed TB diagnosis, reduced treatment initiation, and interrupted contact tracing efforts. 2 As a result, TB notifications dropped by 25% in 2020, signalling significant underreporting and gaps in service delivery. 3 Key services, including drug-resistant TB (DR-TB) management and paediatric TB care, were deprioritized, threatening early detection and continuity of care. 4 Globally, the World Health Organization (WHO) reported that 90% of countries experienced disruptions to TB services, including declines in case detection and treatment initiation. 5 In India, TB notifications fell from 2.4 million in 2019 to 1.8 million in 2020, marking a 24% reduction. 6,7 The Stop TB Partnership warned that these disruptions could result in up to 400,000 additional TB deaths annually, driven largely by delayed diagnosis and treatment. 8 In India, the impact was visible as early as March–April 2020, with a sharp decline in both public and private sector TB notifications, as reported in the Nikshay portal. 9 This underreporting coincided with an increase in undiagnosed and untreated cases, exacerbating community transmission and the future TB burden. 10 Despite numerous global assessments, few studies have explored the indicator-specific impact of COVID-19 on TB within high-burden countries like India. Much of the literature remains aggregate in nature, failing to disaggregate effects by population subgroups or programmatic components. 11 , 12 This creates a pressing need for granular, evidence-driven insights into how each key TB indicator was affected. This study aims to address this gap by assessing the impact of the COVID-19 pandemic on key tuberculosis indicators in India, including trends in case notification. Using secondary data from the India TB Report and WHO estimates, the study evaluates patterns before, during, and after the COVID-19 waves to generate empirical evidence that can inform future preparedness, policy decisions, and TB service resilience. Methods Study design This study employed a comparative interrupted time-series (ITS) design to assess the impact of the COVID-19 pandemic on TB notification trends in India. Thirteen key TB indicators were retrospectively analysed using standardised data from the India TB Report and WHO TB estimates, covering the period 2000–2023 based on data availability. The pre-COVID period was defined as 2000–2019, and the COVID-affected period as 2020–2023. For indicators with limited historical data such as paediatric TB (from 2006), MDR/RR-TB (from 2012), rifampicin-resistant TB, RR-TB among pulmonary TB cases, and household contact tracing notifications (from 2015) the pre-COVID period included all available years up to 2019. Source of data Data are sourced from the India TB Report 16 , 17 , 18 , 19 , 20 , 21 and WHO estimates 22 both recognised as authoritative sources for TB surveillance in India. The India TB Report, published annually by the Central TB Division, MoHFW, provides national-level TB data, including notifications of paediatric TB, bacteriologically confirmed pulmonary TB, all-form TB, and MDR/RR-TB cases. Complementary estimates for TB incidence, TB-HIV co-infection, extrapulmonary TB, rifampicin-resistant TB, household contact tracing, and TB-related mortality are obtained from WHO TB databases. Study variables The study focused on 13 key TB-related indicators obtained from the India TB Report and WHO TB estimates. Detailed information on these indicators is provided in Table 1 Table 1 Description and Classification of Tuberculosis (TB) Indicators Used in the Study Sr. No. Indicator Description Type 1 TB Incidence (India TB Report) Estimated number of new TB cases in a given year Incidence 2 TB-HIV Co-infection (WHO Estimates) Number of TB cases among people living with HIV Incidence 3 Bacteriologically Confirmed Pulmonary TB (India TB Report) New pulmonary TB cases confirmed by bacteriological tests Incidence 4 Extrapulmonary TB (WHO Estimates) Extrapulmonary TB cases—either bacteriologically confirmed or clinically diagnosed Incidence 5 Rifampicin-Resistant TB (WHO Estimates) New TB cases with resistance to rifampicin Incidence 6 Household Contacts (WHO Estimates) Number of household contacts of newly diagnosed bacteriologically confirmed pulmonary TB cases Incidence 7 Notification of All TB Cases (India TB Report) Total notified TB cases across all forms Prevalence 8 Notification of Paediatric TB Cases (India TB Report) Total notified TB cases among children Prevalence 9 RR-TB among Notified Pulmonary TB (WHO Estimates) Proportion of rifampicin-resistant TB among notified bacteriologically confirmed pulmonary TB cases Prevalence 10 MDR/RR-TB Patients Detected (India TB Report) Number of multidrug-resistant or rifampicin-resistant TB patients detected Prevalence 11 TB Deaths – All Forms (WHO Estimates) Total deaths due to TB from all forms Mortality 12 TB Deaths – Excluding HIV (WHO Estimates) TB-related deaths among individuals not infected with HIV Mortality 13 TB Deaths – HIV Positive (WHO Estimates) TB-related deaths among HIV-positive individuals Mortality Statistical analysis We conducted an Interrupted Time Series Analysis (ITSA) using Ordinary Least Squares (OLS) and Generalised Least Squares (GLS) regression to assess the impact of the COVID-19 pandemic on key TB indicators in India. The ITS design was chosen for its strength in evaluating longitudinal effects by comparing trends before and after a disruptive event. This approach captures both immediate shifts and long-term trend changes in TB notifications, detection, and mortality. The analysis began with segmented regression using OLS, followed by refinement through GLS to address autocorrelation and moving average structures in the time series data. GLS models provided more reliable estimates by correcting for serial correlation. The segmented regression model applied is: 𝑌ₜ = 𝛽₀ + 𝛽₁timeₜ + 𝛽₂levelₜ + 𝛽₃trendₜ + 𝜀ₜ , where Yₜ represents the TB outcome at time t , 𝛽₀ is the baseline value, 𝛽₁ is the pre-COVID trend, 𝛽₂ captures the immediate level change post-COVID onset, 𝛽₃ reflects the change in trend post-COVID, and 𝜀ₜ is the error term. A 5% significance level was used to assess both immediate and gradual effects. The visual framework of the statistical analysis is shown in Fig. 1 . Final estimates were derived from GLS models incorporating ARMA structures, identified using the auto.arima() function in R. Model performance was evaluated using AIC, BIC, and log-likelihood values, with the Durbin-Watson statistic guiding lag selection and diagnostics. A comprehensive summary of the GLS-based ITS analysis is presented in Table 2 , highlighting statistically significant coefficients (p < 0.05). The ARMA model results provide robust insights into the disruptions and recovery trends across TB indicators during the COVID-19 period. Results Yearly data for key tuberculosis (TB) indicators were analysed across a 20-year pre-pandemic period and a 4-year pandemic period to assess the impact of the COVID-19 pandemic on TB notification trends in India. The indicators included TB incidence, TB-HIV co-infection, extrapulmonary TB, notification of all TB cases, paediatric TB, and TB-related mortality, disaggregated by all forms, HIV-negative, and HIV-positive categories. Additional indicators such as rifampicin-resistant TB incidence, household contacts of pulmonary TB cases, and RR-TB among notified pulmonary TB cases were analysed using data available for 5 years before the pandemic and 4 years during the pandemic. Bacteriologically confirmed pulmonary TB was assessed using 3 years of pre-pandemic and 4 years of pandemic data, while MDR/RR-TB patient detection was evaluated over an 8-year pre-pandemic and 4-year pandemic period. The analysis revealed that the COVID-19 pandemic caused significant disruptions in TB services and notification systems, with the most severe declines recorded in 2020. Although a few indicators showed partial recovery in subsequent years, most remained below pre-pandemic levels, indicating sustained challenges in TB detection, diagnosis, and reporting. Interrupted Time Series (ITS) analysis employing Generalised Least Squares (GLS) Interrupted Time Series (ITS) analysis using Generalised Least Squares (GLS) with ARMA modelling confirmed these disruptions across multiple indicators. Notifications for bacteriologically confirmed pulmonary TB declined by approximately 292,839 cases, with a p-value of 0.059, indicating a near-significant reduction. Household contact notifications experienced a significant immediate drop of 960,907 cases (p < 0.016), while paediatric TB notifications declined significantly by 61,618 cases (p < 0.001), reflecting the impact of the pandemic on early detection and contact tracing services. Table 2 Estimated Level and Trend Changes in TB Indicators Using GLS-ARMA Approach Interrupted Time Series Analysis Based on the Generalised Least Squares Method (ARMA) Variable GLS Result Value Standard error t value p-value L Limit U Limit TB Incidence Intercept (β0) 36225 260916 0.139 0.891 -475160 547610 Time (β1) 141788 21108 6.717 0.000 100417 183159 Level (β2) -73780 390141 -0.189 0.852 -838441 690882 Trend (β3) -141187 149927 -0.942 0.358 -435038 152665 TB-HIV Co-infection Intercept (β0) 395472 27686 14.284 0.000 341208 449735 Time (β1) -17220 2090 -8.240 0.000 -21317 -13124 Level (β2) -11916 21600 -0.552 0.587 -54252 30420 Trend (β3) 16016 10076 1.590 0.128 -3732 35764 Bacteriologically Confirmed Pulmonary TB Intercept (β0) 817748 102402 7.986 0.004 617043 1018452 Time (β1) 3334 47987 0.069 0.949 -90718 97387 Level (β2) -292839 98829 -2.963 0.059 -486540 -99137 Trend (β3) 137329 49457 2.777 0.069 40395 234262 Extrapulmonary TB (Confirmed/Clinically Diagnosed) Intercept (β0) 63440 32245 1.967 0.063 242 126639 Time (β1) 16409 2576 6.371 0.000 11361 21457 Level (β2) -26641 40382 -0.660 0.517 -105788 52506 Trend (β3) 34174 16359 2.089 0.050 2110 66237 Rifampicin-Resistant TB Incidence Intercept (β0) 144175 1962 73.486 0.000 140330 148020 Time (β1) -6771 600 -11.285 0.000 -7947 -5595 Level (β2) -415 2953 -0.141 0.894 -6203 5372 Trend (β3) 6801 1010 6.732 0.001 4821 8781 Household Contacts of Pulmonary TB Cases Intercept (β0) 2854966 178458 15.998 0.000 2505195 3204737 Time (β1) -2446 54523 -0.045 0.966 -109309 104417 Level (β2) -960907 270692 -3.550 0.016 -1491453 -430361 Trend (β3) 471215 91464 5.152 0.004 291949 650481 Notification of All TB Cases Intercept (β0) 481102 198660 2.422 0.025 91736 870469 Time (β1) 87305 16334 5.345 0.000 55292 119318 Level (β2) -19206 396622 -0.048 0.962 -796570 758159 Trend (β3) -286200 142029 -2.015 0.058 -564572 -7828 Notification of Paediatric TB Cases Intercept (β0) 50781 20798 2.442 0.029 10019 91544 Time (β1) 6051 2111 2.866 0.013 1913 10189 Level (β2) -61618 14621 -4.214 0.001 -90275 -32962 Trend (β3) 9646 7240 1.332 0.204 -4544 23836 RR-TB among Notified Pulmonary TB Cases Intercept (β0) 30764 7181 4.284 0.008 16690 44838 Time (β1) 4510 2196 2.054 0.095 206 8814 Level (β2) -18987 10824 -1.754 0.140 -40200 2227 Trend (β3) -866 3695 -0.234 0.824 -8109 6376 MDR/RR-TB Patients Detected Intercept (β0) 6168 5890 1.047 0.326 -5377 17712 Time (β1) 6697 1155 5.797 0.000 4433 8961 Level (β2) -13461 9609 -1.401 0.199 -32295 5373 Trend (β3) -3820 3418 -1.118 0.296 -10520 2880 TB Deaths All Forms Intercept (β0) 967519 18307 52.850 0.000 931638 1003399 Time (β1) -32865 1495 -21.981 0.000 -35796 -29935 Level (β2) 44276 32163 1.377 0.184 -18762 107314 Trend (β3) 25476 11844 2.151 0.044 2262 48691 TB Deaths Excluding HIV Intercept (β0) 789722 30941 25.523 0.000 729079 850367 Time (β1) -24374 2048 -11.901 0.000 -28388 -20360 Level (β2) 21399 14952 1.431 0.168 -7907 50706 Trend (β3) 18856 7680 2.455 0.023 3803 33909 TB Deaths – HIV Positive Intercept (β0) 212322 5306 40.013 0.000 201922 222722 Time (β1) -9649 445 -21.681 0.000 -10521 -8776 Level (β2) 4560 17819 0.256 0.801 -30365 39484 Trend (β3) 5517 6341 0.870 0.395 -6912 17945 Immediate and Overall Effects During the COVID-19 Pandemic The immediate and overall effects of the COVID-19 pandemic are summarised in Table 3 . Compared to the pre-COVID-19 period, TB incidence declined by 7.13–18.57% between 2020 and 2023. Notifications of all TB cases dropped substantially, ranging from 12.22–52.97%. Paediatric TB notifications recorded the sharpest initial drop of 45.01% in 2020, followed by a gradual recovery, with a decline narrowed to 14.45% by 2023. Notifications of RR-TB among pulmonary TB cases fell by 36.62% in 2020 and remained 32.01% below baseline in 2023. Similarly, MDR/RR-TB case detection dropped by 25.02–34.22% during the pandemic period, indicating a prolonged disruption in identifying and reporting drug-resistant TB cases. Notifications related to household contacts of pulmonary TB cases declined by 18.46% in 2020 but showed a consistent upward trend from 2021 onward, reaching a 30.41% increase by 2023, indicating a phased recovery in contact tracing activities. Indicators that showed positive progress before the pandemic, such as TB-HIV co-infection, extrapulmonary TB, and rifampicin-resistant TB incidence, reversed direction post-2020, with increases ranging from 12.11–34.63%. These reversals likely reflect delayed diagnoses and reduced healthcare access during the pandemic. TB mortality, which had steadily declined from 2000 to 2019, rose sharply in the post-pandemic period. Notifications of TB deaths (all forms) increased by 22.95–85.65%. TB deaths excluding HIV rose by 5.30–51.47%, and HIV-associated TB deaths surged by 96.83% in 2020 alone. These findings highlight the significant and lasting impact of the COVID-19 pandemic on TB notifications and mortality, underscoring the urgent need for robust and resilient TB service delivery systems in the face of public health emergencies. Table 3 TB Indicators Assessed for Immediate and Overall Effects During the COVID-19 Pandemic Variable Period Observed value Counterfactual Absolute change Relative change (%) TB Incidence Immediate effect 2798800 3013766 -214966 -7.13 Overall effect 2800603 3439129 -638526 -18.57 TB-HIV Co-infection Immediate effect 37944 33844 4099 12.11 Overall effect 34330 -17817 52147 -292.68 Bacteriologically Confirmed Pulmonary TB Immediate effect 679447 812369 -132921 -16.36 Overall effect 1104590 797264 307325 38.55 Extrapulmonary TB (Confirmed/Clinically Diagnosed) Immediate effect 443647 383976 59671 15.54 Overall effect 576658 428325 148333 34.63 Rifampicin-Resistant TB Incidence Immediate effect 110196 103718 6478 6.25 Overall effect 109900 83802 26097 31.14 Household Contacts of Pulmonary TB Cases Immediate effect 2337292 2866354 -529062 -18.46 Overall effect 3759167 2882649 876517 30.41 Notification of All TB Cases Immediate effect 2045542 2330371 -284829 -12.22 Overall effect 1220918 2596184 -1375266 -52.97 Notification of Paediatric TB Cases Immediate effect 77149 140296 -63147 -45.01 Overall effect 135644 158547 -22903 -14.45 RR-TB among Notified Pulmonary TB Cases Immediate effect 37131 58584 -21453 -36.62 Overall effect 49225 72399 -23174 -32.01 MDR/RR-TB Patients Detected Immediate effect 49731 66322 -16591 -25.02 Overall effect 56789 86330 -29541 -34.22 TB Deaths All Forms Immediate effect 341493 277748 63745 22.95 Overall effect 333378 179573 153805 85.65 TB Deaths Excluding HIV Immediate effect 291142 276488 14654 5.30 Overall effect 310464 204962 105501 51.47 TB Deaths HIV Positive Immediate effect 18737 9519 9217 96.83 Overall effect 7762 -19544 27306 -139.72 Discussion The COVID-19 pandemic has significantly disrupted tuberculosis (TB) control efforts worldwide, with India experiencing some of the most severe setbacks. According to the WHO Global Tuberculosis Report 2021, India contributed approximately 41% of the global reduction in newly detected TB cases in 2020, reflecting the fragility of TB surveillance systems in the face of health emergencies. 13 Monthly TB notifications in India plummeted by nearly 70% in April 2020, compared to the same month in 2019, marking an unprecedented collapse in detection and reporting mechanisms. 14 This sharp decline mirrored patterns observed across other high-burden countries in Southeast Asia and sub-Saharan Africa, where health system disruptions, mobility restrictions, and resource reallocation severely impeded TB detection and treatment services. 15 In India, several factors compounded the crisis: strict lockdowns, the repurposing of healthcare workers and diagnostic platforms for COVID-19, fear of nosocomial infection, and widespread stigma around respiratory symptoms. The shutdown of rural health centers, limited availability of CBNAAT and TrueNat testing, and disruptions in sample transport networks further strained the diagnostic cascade. Delays in care-seeking, especially among vulnerable groups such as children, drug-resistant TB patients, and people living with HIV (PLHIV), intensified the magnitude of underreporting. 4 Despite these challenges, the Government of India initiated several adaptive measures, including catch-up campaigns, bidirectional screening for TB and COVID-19, and the gradual restoration of diagnostic services. However, the impact on TB indicators varied across subpopulations. Figure 2 presents the interrupted time series visual results, capturing both short-term disruptions and long-term changes in TB indicators during the COVID-19 pandemic in India. For instance, paediatric TB notifications declined more sharply than adult cases, dropping by 45.01% in 2020, reflecting both diagnostic limitations in children and reduced care-seeking behavior during the lockdown. Although a partial recovery was observed by 2023 (14.45% below 2019 levels), the lag remains concerning given the vulnerability of this subgroup. Similarly, drug-resistant TB (DR-TB) detection suffered significant setbacks. Notifications of rifampicin-resistant TB (RR-TB) among pulmonary cases fell by 36.62% in 2020, with only modest improvements by 2023 (still 32.01% below pre-pandemic levels). The number of MDR/RR-TB patients detected also declined, indicating prolonged stress on laboratory capacity and drug susceptibility testing infrastructure. These trends suggest that specialized diagnostic services, which are critical for DR-TB detection, were disproportionately affected due to higher resource demands and longer diagnostic pathways. 3 Contact tracing activities integral to both prevention and early detection—initially declined by 18.46% in 2020, but encouragingly, rebounded by 30.41% in 2023, potentially due to intensified programmatic focus and recovery of human resources. While this resurgence is notable, it likely does not offset the backlog of missed or undiagnosed cases accumulated during the peak disruption periods. An unexpected post-pandemic trend was the increase in certain TB indicators that had previously shown steady declines. TB-HIV co-infection, extrapulmonary TB, and rifampicin-resistant TB cases all reported increases between 12.11% and 34.63%, likely reflecting the consequences of delayed diagnoses and the reappearance of previously undetected cases once services resumed. These increases may not signify a genuine rise in disease burden but rather a "catch-up" phenomenon from the suppressed detection period. Perhaps the most alarming finding was the sharp rise in TB-related mortality. Notifications of TB deaths (all forms) increased by up to 85.65%, with deaths among HIV-negative TB patients rising between 5.30% and 51.47%, and HIV-associated TB deaths increasing by nearly 97% in 2020. These figures represent a dramatic reversal after years of progress and highlight the lethal consequences of diagnostic delays, treatment interruptions, and loss to follow-up during the pandemic. Collectively, these results illustrate how the pandemic not only disrupted TB service delivery but reversed decades of progress made under the National TB Elimination Programme (NTEP). The fragility of the TB control ecosystem in India was exposed, particularly in areas requiring specialized care and diagnostics. The partial recovery through 2023 signals resilience but also underlines persistent service gaps. To mitigate future disruptions, India must prioritize building a resilient health system by ensuring robust surveillance mechanisms capable of operating during crises, integrating TB and COVID-19 services particularly in areas of screening and diagnostics—and securing sustained funding for TB programs and diagnostic infrastructure. Special attention should be given to protecting vulnerable subpopulations such as children, patients with drug-resistant TB (DR-TB), and people living with HIV (PLHIV). Furthermore, enhancing community engagement and reducing stigma are critical for improving care-seeking behaviour. Adopting a syntomic approach that acknowledges the complex interplay between TB, COVID-19, and broader social determinants of health will be crucial for designing inclusive and effective TB control strategies in the post-pandemic landscape. Conclusion COVID-19 pandemic severely disrupted TB notification trends in India, with the most significant decline in 2020, reflecting weakened surveillance, detection, and reporting systems. The resulting underdiagnosis and delayed treatment pose serious risks for increased transmission and disease burden. Strengthening TB monitoring, expanding active case finding, and investing in digital and community-based interventions are essential to restore services and prevent long-term setbacks. Declarations Ethical approval: The study did not require institutional review as the data used were already publicly accessible. Declaration of interests: The authors state that there are no competing interests associated with the content of this manuscript. PKS and ANK have no financial, personal, or professional affiliations that might be seen as influencing the findings of this study. This research was undertaken independently and was not influenced by any commercial or financial organisations that could pose a conflict of interest. All opinions expressed are those of the authors alone. Funding: No financial support was received by the authors for the conduct of this study. Author Contribution PKS was responsible for the conception, design, data collection, data analysis, interpretation of results, and drafting of the manuscript. ANK contributed by reviewing and providing critical feedback on the manuscript for intellectual content and accuracy. Data Availability The datasets used in this study are publicly available from the sources cited in the manuscript. Indicators, including TB-HIV co-infection, extrapulmonary TB, rifampicin-resistant TB, household contacts, RR-TB among notified pulmonary TB, TB deaths (all forms), TB deaths excluding HIV, and TB deaths among HIV-positive cases were obtained from the WHO estimates dataset, accessible through the [ [Global Programme on Tuberculosis & Lung Health](https:/www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/data) ]. Additional indicators such as TB incidence, bacteriologically confirmed pulmonary TB, notification of all TB cases, notification of paediatric TB cases, and MDR/RR-TB patients detected were extracted from the India TB Reports, available as referenced PDF documents via direct web links [ [Annual Reports – Central Tuberculosis Division](https:/tbcindia.mohfw.gov.in/annual-reports) ]. All details have been cited in the Data Source section (citations 16–22), with the corresponding file names and links listed in the Reference section: 16. Central TB Division. (2013). TB-India-2013.pdf17. Central TB Division. (2014). AU1023.pdf18. Central TB Division. (2018). TB-India-Report-2018.pdf19. Central TB Division. (2022). TBAnnualReport2022.pdf20. Central TB Division. (2024). TB-Report_for-Web_08_10-2024-1.pdf21. India achieved record TB notification in 2023 – The Hindu22. Global Programme on Tuberculosis & Lung Health References World Health Organization. Global Tuberculosis Report 2023. Geneva: WHO; 2023. The Lancet. India's COVID-19 Emergency. Lancet. 2021;397(10286):1683. Central TB, Division. India TB Report 2023. Ministry of Health and Family Welfare, Government of India; 2023. Bhargava A, Shewade HD. The potential impact of the COVID-19 response on tuberculosis in high-burden countries: a modelling analysis. Stop TB Partnership; 2020. World Health Organization. Global Tuberculosis Report 2022. Geneva: WHO; 2022. Central TB, Division. India TB Report 2021. Ministry of Health and Family Welfare, Government of India; 2021. World Health Organization. (2021). The impact of the COVID-19 pandemic on TB detection and mortality in 2020. Hogan AB, Jewell BL, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Global Health. 2020;8(9):e1132–41. Nikshay Portal. National TB Case Notification Reports. India: Central TB Division; 2020. Central TB, Division. India TB Report 2022. Ministry of Health and Family Welfare, Government of India; 2022. Cilloni L, Fu H, Vesga JF, et al. The potential impact of the COVID-19 pandemic on the tuberculosis epidemic: a modelling analysis. EClinicalMedicine. 2020;28:100603. Stop TBP. (2020). The potential impact of the COVID-19 response on tuberculosis in high-burden countries: A modelling analysis . WHO. Global Tuberculosis Report 2021 . https://www.who.int/publications/i/item/9789240037021 Stop TB, Partnership. The devastating effect of the COVID-19 pandemic on the TB response – a global analysis . https://www.stoptb.org WHO. Impact of COVID-19 on TB services . https://www.who.int/news-room/fact-sheets/detail/tuberculosis Central TB, Division. (2013). TB-India-2013.pdf . Central TB, Division. (2014). AU1023.pdf . Central TB, Division. (2018). TB-India-Report-2018.pdf . Central TB, Division. (2022). TBAnnualReport2022.pdf . Central TB, Division. (2024). TB-Report_for-Web_08_10-2024-1.pdf . India achieved record TB notification in 2023 – The Hindu. Global Programme on Tuberculosis. & Lung Health. Additional Declarations No competing interests reported. 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Khan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYJCCAwwMzMz8/I2ND4AcHj5itbBLzjjcbADSwkakRcz8BgfS2yRATIJazNmPPzxc8cta2uDAwbbKrzl2MmwMzA8f3cCjxbInx+Dg2b50Y8nDjW23ZbclAx3GZmycg0eLwYEchoONPYeT+YC23JbcxgzUwsMmjVfL+ecPQFrqGw4kthVLbqsnQsuNBIODDT8OMwsAtTB+3HaYGC1vDA42NqQzS8442CzNuO04DxszIb+cT3/8seGPNTAq2x9+/Lmt2p6fvfnhY3xawICxDUIz84BJQsrB4A9U6w+iVI+CUTAKRsFIAwDnE1DmmsAXnwAAAABJRU5ErkJggg==","orcid":"","institution":"Dr.Vishwanath Karad MIT WORLD PEACE UNIVERSITY","correspondingAuthor":true,"prefix":"","firstName":"Abdul","middleName":"Nasir","lastName":"Khan","suffix":""}],"badges":[],"createdAt":"2025-08-30 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02:24:13","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100341,"visible":true,"origin":"","legend":"","description":"","filename":"beacb7a7270943fe81134789e84065d61structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7495327/v1/ac2be58c635529fea0a0dbb7.xml"},{"id":94236768,"identity":"66ad0ea7-e137-410b-9d8e-a8d50fc8c6f6","added_by":"auto","created_at":"2025-10-24 02:16:13","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":104073,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7495327/v1/586bc48bfdd5a414b99389c3.html"},{"id":94236761,"identity":"9fe09c08-d8e8-4085-8dfb-48ae6ecc84d6","added_by":"auto","created_at":"2025-10-24 02:16:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":140572,"visible":true,"origin":"","legend":"\u003cp\u003eVisual representation of a segmented linear regression model applied to interrupted time series (ITS) data.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7495327/v1/cb389a27d2839e856e81f8c0.png"},{"id":94237357,"identity":"edd11bbe-f038-419c-856f-99ce6d609cbe","added_by":"auto","created_at":"2025-10-24 02:24:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1010299,"visible":true,"origin":"","legend":"\u003cp\u003eVisualisation of interrupted time series results capturing short-term disruptions and long-term changes in TB indicators due to the COVID-19 pandemic in India\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7495327/v1/ffc4cd9248d13d729a783e98.png"},{"id":94238078,"identity":"af307eb6-d3ca-4503-9529-ec38be965c4a","added_by":"auto","created_at":"2025-10-24 02:40:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2335502,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7495327/v1/7e4eb040-4baa-4dee-82b2-406e76db0362.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"From Progress to Disruption: Unveiling the Hidden Impact of COVID-19 on Tuberculosis Indicators in India","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTuberculosis (TB) remains a critical public health concern in India, which continues to bear the world\u0026rsquo;s highest burden of the disease. Despite decades of targeted interventions, TB accounted for approximately 28% of the global incidence in 2019, highlighting persistent gaps in prevention, detection, and care delivery.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Since the early 2000s, India has undertaken extensive efforts to strengthen TB surveillance and notification through the Revised National Tuberculosis Control Programme (RNTCP), later rebranded as the National TB Elimination Programme (NTEP). These efforts, supported by the introduction of digital reporting systems (Nikshay), public-private mix models, and expanded diagnostic capacity, have led to substantial improvements in the notification of all TB cases, including bacteriologically confirmed pulmonary TB, paediatric TB, extrapulmonary TB, and drug-resistant forms such as rifampicin-resistant (RR-TB) and multidrug-resistant TB (MDR-TB).\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eBetween 2000 and 2019, India implemented several strategic health system interventions aimed at improving TB detection, notification, and treatment outcomes. During this period, the estimated TB incidence showed a slow but steady decline, reflecting the impact of programmatic efforts under the RNTCP, now renamed the NTEP.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Notification of all TB cases increased substantially from under 1\u0026nbsp;million in the early 2000s to over 2.4\u0026nbsp;million by 2019 owing to the scale-up of mandatory notification policies, improved reporting from the private sector, and digital surveillance through the Nikshay portal.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eBacteriologically confirmed pulmonary TB cases steadily increased as diagnostic capacity expanded, including the deployment of CBNAAT and TrueNat platforms.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Paediatric TB notifications also improved due to enhanced training and diagnostic outreach, though underreporting remained a challenge. Extrapulmonary TB maintained a consistent share of reported cases, around 15\u0026ndash;20%, supported by better clinical awareness and guidelines.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e TB-HIV co-infection management improved through intensified testing and ART scale-up, which helped reduce co-infection rates and mortality over time\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIndia also made notable progress in drug-resistant TB management. The number of MDR/RR-TB patients detected rose significantly, from fewer than 10,000 in the early 2010s to over 60,000 by 2019.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The proportion of rifampicin-resistant TB among notified pulmonary cases gradually stabilised, supported by the nationwide rollout of universal drug susceptibility testing.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Household contact tracing and preventive therapy initiatives were introduced and expanded, though coverage remained below targets.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTB-related mortality declined gradually during this period. WHO estimates indicate that TB deaths (all forms) fell due to expanded treatment access and the integration of TB and HIV services. However, the burden remained high, with nearly 450,000 deaths annually by 2019 (excluding HIV-positive individuals), and around 12,000\u0026ndash;15,000 annual deaths among PLHIV with TB.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003ePrior to the COVID-19 pandemic, India had made significant strides under the National Strategic Plan for TB Elimination (2017\u0026ndash;2025) and the RNTCP, aligning with the targets of the WHO\u0026rsquo;s End TB Strategy.\u003c/p\u003e\u003cp\u003eThe advent of the COVID-19 pandemic in early 2020 caused unprecedented disruptions to health systems worldwide. In India, nationwide lockdowns, travel restrictions, and the diversion of health resources to the pandemic response delayed TB diagnosis, reduced treatment initiation, and interrupted contact tracing efforts.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e As a result, TB notifications dropped by 25% in 2020, signalling significant underreporting and gaps in service delivery. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Key services, including drug-resistant TB (DR-TB) management and paediatric TB care, were deprioritized, threatening early detection and continuity of care.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eGlobally, the World Health Organization (WHO) reported that 90% of countries experienced disruptions to TB services, including declines in case detection and treatment initiation.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn India, TB notifications fell from 2.4\u0026nbsp;million in 2019 to 1.8\u0026nbsp;million in 2020, marking a 24% reduction.\u003csup\u003e6,7\u003c/sup\u003e The Stop TB Partnership warned that these disruptions could result in up to 400,000 additional TB deaths annually, driven largely by delayed diagnosis and treatment.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn India, the impact was visible as early as March\u0026ndash;April 2020, with a sharp decline in both public and private sector TB notifications, as reported in the Nikshay portal.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e This underreporting coincided with an increase in undiagnosed and untreated cases, exacerbating community transmission and the future TB burden.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDespite numerous global assessments, few studies have explored the indicator-specific impact of COVID-19 on TB within high-burden countries like India. Much of the literature remains aggregate in nature, failing to disaggregate effects by population subgroups or programmatic components. \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e This creates a pressing need for granular, evidence-driven insights into how each key TB indicator was affected.\u003c/p\u003e\u003cp\u003eThis study aims to address this gap by assessing the impact of the COVID-19 pandemic on key tuberculosis indicators in India, including trends in case notification. Using secondary data from the India TB Report and WHO estimates, the study evaluates patterns before, during, and after the COVID-19 waves to generate empirical evidence that can inform future preparedness, policy decisions, and TB service resilience.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eThis study employed a comparative interrupted time-series (ITS) design to assess the impact of the COVID-19 pandemic on TB notification trends in India. Thirteen key TB indicators were retrospectively analysed using standardised data from the India TB Report and WHO TB estimates, covering the period 2000\u0026ndash;2023 based on data availability. The pre-COVID period was defined as 2000\u0026ndash;2019, and the COVID-affected period as 2020\u0026ndash;2023. For indicators with limited historical data such as paediatric TB (from 2006), MDR/RR-TB (from 2012), rifampicin-resistant TB, RR-TB among pulmonary TB cases, and household contact tracing notifications (from 2015) the pre-COVID period included all available years up to 2019.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSource of data\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eData are sourced from the India TB Report \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e and WHO estimates\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e both recognised as authoritative sources for TB surveillance in India. The India TB Report, published annually by the Central TB Division, MoHFW, provides national-level TB data, including notifications of paediatric TB, bacteriologically confirmed pulmonary TB, all-form TB, and MDR/RR-TB cases. Complementary estimates for TB incidence, TB-HIV co-infection, extrapulmonary TB, rifampicin-resistant TB, household contact tracing, and TB-related mortality are obtained from WHO TB databases.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eStudy variables\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe study focused on 13 key TB-related indicators obtained from the India TB Report and WHO TB estimates. Detailed information on these indicators is provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription and Classification of Tuberculosis (TB) Indicators Used in the Study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSr. No.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eType\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTB Incidence (India TB Report)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEstimated number of new TB cases in a given year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTB-HIV Co-infection (WHO Estimates)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of TB cases among people living with HIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBacteriologically Confirmed Pulmonary TB (India TB Report)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNew pulmonary TB cases confirmed by bacteriological tests\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtrapulmonary TB (WHO Estimates)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExtrapulmonary TB cases\u0026mdash;either bacteriologically confirmed or clinically diagnosed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRifampicin-Resistant TB (WHO Estimates)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNew TB cases with resistance to rifampicin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousehold Contacts (WHO Estimates)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of household contacts of newly diagnosed bacteriologically confirmed pulmonary TB cases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNotification of All TB Cases (India TB Report)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal notified TB cases across all forms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePrevalence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNotification of Paediatric TB Cases (India TB Report)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal notified TB cases among children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePrevalence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRR-TB among Notified Pulmonary TB (WHO Estimates)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion of rifampicin-resistant TB among notified bacteriologically confirmed pulmonary TB cases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePrevalence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMDR/RR-TB Patients Detected (India TB Report)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of multidrug-resistant or rifampicin-resistant TB patients detected\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePrevalence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTB Deaths \u0026ndash; All Forms (WHO Estimates)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal deaths due to TB from all forms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMortality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTB Deaths \u0026ndash; Excluding HIV (WHO Estimates)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTB-related deaths among individuals not infected with HIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMortality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTB Deaths \u0026ndash; HIV Positive (WHO Estimates)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTB-related deaths among HIV-positive individuals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMortality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eWe conducted an Interrupted Time Series Analysis (ITSA) using Ordinary Least Squares (OLS) and Generalised Least Squares (GLS) regression to assess the impact of the COVID-19 pandemic on key TB indicators in India. The ITS design was chosen for its strength in evaluating longitudinal effects by comparing trends before and after a disruptive event. This approach captures both immediate shifts and long-term trend changes in TB notifications, detection, and mortality.\u003c/p\u003e\u003cp\u003eThe analysis began with segmented regression using OLS, followed by refinement through GLS to address autocorrelation and moving average structures in the time series data. GLS models provided more reliable estimates by correcting for serial correlation.\u003c/p\u003e\u003cp\u003eThe segmented regression model applied is:\u003c/p\u003e\u003cp\u003e\u003cb\u003e\u0026#119884;ₜ = \u0026#120573;₀ + \u0026#120573;₁timeₜ + \u0026#120573;₂levelₜ + \u0026#120573;₃trendₜ + \u0026#120576;ₜ\u003c/b\u003e,\u003c/p\u003e\u003cp\u003ewhere \u003cem\u003eYₜ\u003c/em\u003e represents the TB outcome at time \u003cem\u003et\u003c/em\u003e, \u0026#120573;₀ is the baseline value, \u0026#120573;₁ is the pre-COVID trend, \u0026#120573;₂ captures the immediate level change post-COVID onset, \u0026#120573;₃ reflects the change in trend post-COVID, and \u0026#120576;ₜ is the error term. A 5% significance level was used to assess both immediate and gradual effects. The visual framework of the statistical analysis is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eFinal estimates were derived from GLS models incorporating ARMA structures, identified using the \u003cem\u003eauto.arima()\u003c/em\u003e function in R. Model performance was evaluated using AIC, BIC, and log-likelihood values, with the Durbin-Watson statistic guiding lag selection and diagnostics.\u003c/p\u003e\u003cp\u003eA comprehensive summary of the GLS-based ITS analysis is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, highlighting statistically significant coefficients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The ARMA model results provide robust insights into the disruptions and recovery trends across TB indicators during the COVID-19 period.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eYearly data for key tuberculosis (TB) indicators were analysed across a 20-year pre-pandemic period and a 4-year pandemic period to assess the impact of the COVID-19 pandemic on TB notification trends in India. The indicators included TB incidence, TB-HIV co-infection, extrapulmonary TB, notification of all TB cases, paediatric TB, and TB-related mortality, disaggregated by all forms, HIV-negative, and HIV-positive categories. Additional indicators such as rifampicin-resistant TB incidence, household contacts of pulmonary TB cases, and RR-TB among notified pulmonary TB cases were analysed using data available for 5 years before the pandemic and 4 years during the pandemic. Bacteriologically confirmed pulmonary TB was assessed using 3 years of pre-pandemic and 4 years of pandemic data, while MDR/RR-TB patient detection was evaluated over an 8-year pre-pandemic and 4-year pandemic period. The analysis revealed that the COVID-19 pandemic caused significant disruptions in TB services and notification systems, with the most severe declines recorded in 2020. Although a few indicators showed partial recovery in subsequent years, most remained below pre-pandemic levels, indicating sustained challenges in TB detection, diagnosis, and reporting.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eInterrupted Time Series (ITS) analysis employing Generalised Least Squares (GLS)\u003c/h2\u003e\u003cp\u003eInterrupted Time Series (ITS) analysis using Generalised Least Squares (GLS) with ARMA modelling confirmed these disruptions across multiple indicators. Notifications for bacteriologically confirmed pulmonary TB declined by approximately 292,839 cases, with a p-value of 0.059, indicating a near-significant reduction. Household contact notifications experienced a significant immediate drop of 960,907 cases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.016), while paediatric TB notifications declined significantly by 61,618 cases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reflecting the impact of the pandemic on early detection and contact tracing services.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEstimated Level and Trend Changes in TB Indicators Using GLS-ARMA Approach\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eInterrupted Time Series Analysis Based on the Generalised Least Squares Method (ARMA)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVariable\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGLS Result\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandard error\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003et value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eL Limit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eU Limit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eTB Incidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e260916\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.891\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-475160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e547610\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e141788\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.717\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e100417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e183159\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-73780\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e390141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-838441\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e690882\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-141187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e149927\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.942\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-435038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e152665\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eTB-HIV Co-infection\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e395472\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27686\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e341208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e449735\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-17220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2090\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-8.240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-21317\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-13124\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-11916\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21600\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.552\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.587\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-54252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30420\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.590\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-3732\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e35764\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eBacteriologically Confirmed Pulmonary TB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e817748\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.986\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e617043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1018452\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3334\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.949\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-90718\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e97387\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-292839\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98829\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.963\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-486540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-99137\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137329\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49457\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.777\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e234262\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eExtrapulmonary TB (Confirmed/Clinically Diagnosed)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63440\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.967\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e242\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e126639\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16409\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11361\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e21457\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-26641\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.660\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-105788\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e52506\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16359\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e66237\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eRifampicin-Resistant TB Incidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1962\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e73.486\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e140330\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e148020\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-6771\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e600\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-11.285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-7947\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-5595\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-415\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2953\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.894\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-6203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5372\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6801\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.732\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4821\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8781\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eHousehold Contacts of Pulmonary TB Cases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2854966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e178458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.998\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2505195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3204737\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2446\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54523\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-109309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e104417\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-960907\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e270692\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.550\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1491453\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-430361\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e471215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e291949\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e650481\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eNotification of All TB Cases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e481102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e198660\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.422\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e91736\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e870469\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87305\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16334\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e55292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e119318\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-19206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e396622\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.962\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-796570\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e758159\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-286200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e142029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-564572\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-7828\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eNotification of Paediatric TB Cases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50781\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.442\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e91544\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.866\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1913\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10189\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-61618\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-4.214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-90275\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-32962\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9646\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.332\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-4544\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e23836\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eRR-TB among Notified Pulmonary TB Cases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30764\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16690\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e44838\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4510\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8814\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-18987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10824\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-40200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2227\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-866\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3695\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.824\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-8109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6376\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eMDR/RR-TB Patients Detected\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5890\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.326\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-5377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e17712\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6697\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.797\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8961\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-13461\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9609\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.401\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.199\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-32295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5373\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-3820\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3418\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-10520\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2880\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eTB Deaths All Forms\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e967519\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18307\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52.850\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e931638\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1003399\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-32865\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1495\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-21.981\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-35796\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-29935\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-18762\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e107314\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11844\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.044\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e48691\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eTB Deaths Excluding HIV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e789722\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30941\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.523\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e729079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e850367\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-24374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-11.901\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-28388\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-20360\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14952\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.431\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-7907\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e50706\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18856\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7680\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.455\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3803\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e33909\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eTB Deaths \u0026ndash; HIV Positive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept (β0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e212322\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e201922\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e222722\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime (β1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-9649\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e445\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-21.681\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-10521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-8776\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel (β2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4560\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17819\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.801\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-30365\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e39484\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrend (β3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.870\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-6912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e17945\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eImmediate and Overall Effects During the COVID-19 Pandemic\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe immediate and overall effects of the COVID-19 pandemic are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Compared to the pre-COVID-19 period, TB incidence declined by 7.13\u0026ndash;18.57% between 2020 and 2023. Notifications of all TB cases dropped substantially, ranging from 12.22\u0026ndash;52.97%. Paediatric TB notifications recorded the sharpest initial drop of 45.01% in 2020, followed by a gradual recovery, with a decline narrowed to 14.45% by 2023. Notifications of RR-TB among pulmonary TB cases fell by 36.62% in 2020 and remained 32.01% below baseline in 2023. Similarly, MDR/RR-TB case detection dropped by 25.02\u0026ndash;34.22% during the pandemic period, indicating a prolonged disruption in identifying and reporting drug-resistant TB cases. Notifications related to household contacts of pulmonary TB cases declined by 18.46% in 2020 but showed a consistent upward trend from 2021 onward, reaching a 30.41% increase by 2023, indicating a phased recovery in contact tracing activities. Indicators that showed positive progress before the pandemic, such as TB-HIV co-infection, extrapulmonary TB, and rifampicin-resistant TB incidence, reversed direction post-2020, with increases ranging from 12.11\u0026ndash;34.63%. These reversals likely reflect delayed diagnoses and reduced healthcare access during the pandemic. TB mortality, which had steadily declined from 2000 to 2019, rose sharply in the post-pandemic period. Notifications of TB deaths (all forms) increased by 22.95\u0026ndash;85.65%. TB deaths excluding HIV rose by 5.30\u0026ndash;51.47%, and HIV-associated TB deaths surged by 96.83% in 2020 alone. These findings highlight the significant and lasting impact of the COVID-19 pandemic on TB notifications and mortality, underscoring the urgent need for robust and resilient TB service delivery systems in the face of public health emergencies.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTB Indicators Assessed for Immediate and Overall Effects During the COVID-19 Pandemic\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriod\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eObserved value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCounterfactual\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAbsolute change\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRelative change (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTB Incidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2798800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3013766\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-214966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-7.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2800603\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3439129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-638526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-18.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTB-HIV Co-infection\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37944\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33844\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34330\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-17817\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-292.68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eBacteriologically Confirmed Pulmonary TB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e679447\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e812369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-132921\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-16.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1104590\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e797264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e307325\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e38.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eExtrapulmonary TB (Confirmed/Clinically Diagnosed)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e443647\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e383976\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e576658\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e428325\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e148333\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e34.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eRifampicin-Resistant TB Incidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103718\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6478\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e109900\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83802\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26097\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e31.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eHousehold Contacts of Pulmonary TB Cases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2337292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2866354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-529062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-18.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3759167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2882649\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e876517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e30.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eNotification of All TB Cases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2045542\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2330371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-284829\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-12.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1220918\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2596184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1375266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-52.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eNotification of Paediatric TB Cases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e140296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-63147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-45.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e135644\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e158547\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-22903\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-14.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eRR-TB among Notified Pulmonary TB Cases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58584\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-21453\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-36.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-23174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-32.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMDR/RR-TB Patients Detected\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49731\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66322\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-16591\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-25.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56789\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86330\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-29541\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-34.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTB Deaths All Forms\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e341493\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e277748\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63745\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e22.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e333378\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e179573\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e153805\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e85.65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTB Deaths Excluding HIV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e291142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e276488\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14654\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e310464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e204962\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e105501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e51.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTB Deaths HIV Positive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18737\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9519\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e96.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7762\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-19544\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-139.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe COVID-19 pandemic has significantly disrupted tuberculosis (TB) control efforts worldwide, with India experiencing some of the most severe setbacks. According to the WHO Global Tuberculosis Report 2021, India contributed approximately 41% of the global reduction in newly detected TB cases in 2020, reflecting the fragility of TB surveillance systems in the face of health emergencies.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Monthly TB notifications in India plummeted by nearly 70% in April 2020, compared to the same month in 2019, marking an unprecedented collapse in detection and reporting mechanisms. \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis sharp decline mirrored patterns observed across other high-burden countries in Southeast Asia and sub-Saharan Africa, where health system disruptions, mobility restrictions, and resource reallocation severely impeded TB detection and treatment services.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e In India, several factors compounded the crisis: strict lockdowns, the repurposing of healthcare workers and diagnostic platforms for\u003c/p\u003e\u003cp\u003eCOVID-19, fear of nosocomial infection, and widespread stigma around respiratory symptoms. The shutdown of rural health centers, limited availability of CBNAAT and TrueNat testing, and disruptions in sample transport networks further strained the diagnostic cascade. Delays in care-seeking, especially among vulnerable groups such as children, drug-resistant TB patients, and people living with HIV (PLHIV), intensified the magnitude of underreporting. \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDespite these challenges, the Government of India initiated several adaptive measures, including catch-up campaigns, bidirectional screening for TB and COVID-19, and the gradual restoration of diagnostic services. However, the impact on TB indicators varied across subpopulations. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the interrupted time series visual results, capturing both short-term disruptions and long-term changes in TB indicators during the COVID-19 pandemic in India.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFor instance, paediatric TB notifications declined more sharply than adult cases, dropping by 45.01% in 2020, reflecting both diagnostic limitations in children and reduced care-seeking behavior during the lockdown. Although a partial recovery was observed by 2023 (14.45% below 2019 levels), the lag remains concerning given the vulnerability of this subgroup.\u003c/p\u003e\u003cp\u003eSimilarly, drug-resistant TB (DR-TB) detection suffered significant setbacks. Notifications of rifampicin-resistant TB (RR-TB) among pulmonary cases fell by 36.62% in 2020, with only modest improvements by 2023 (still 32.01% below pre-pandemic levels). The number of MDR/RR-TB patients detected also declined, indicating prolonged stress on laboratory capacity and drug susceptibility testing infrastructure. These trends suggest that specialized diagnostic services, which are critical for DR-TB detection, were disproportionately affected due to higher resource demands and longer diagnostic pathways.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Contact tracing activities integral to both prevention and early detection\u0026mdash;initially declined by 18.46% in 2020, but encouragingly, rebounded by 30.41% in 2023, potentially due to intensified programmatic focus and recovery of human resources. While this resurgence is notable, it likely does not offset the backlog of missed or undiagnosed cases accumulated during the peak disruption periods.\u003c/p\u003e\u003cp\u003eAn unexpected post-pandemic trend was the increase in certain TB indicators that had previously shown steady declines. TB-HIV co-infection, extrapulmonary TB, and rifampicin-resistant TB cases all reported increases between 12.11% and 34.63%, likely reflecting the consequences of delayed diagnoses and the reappearance of previously undetected cases once services resumed. These increases may not signify a genuine rise in disease burden but rather a \"catch-up\" phenomenon from the suppressed detection period.\u003c/p\u003e\u003cp\u003ePerhaps the most alarming finding was the sharp rise in TB-related mortality. Notifications of TB deaths (all forms) increased by up to 85.65%, with deaths among HIV-negative TB patients rising between 5.30% and 51.47%, and HIV-associated TB deaths increasing by nearly 97% in 2020. These figures represent a dramatic reversal after years of progress and highlight the lethal consequences of diagnostic delays, treatment interruptions, and loss to follow-up during the pandemic. Collectively, these results illustrate how the pandemic not only disrupted TB service\u003c/p\u003e\u003cp\u003edelivery but reversed decades of progress made under the National TB Elimination Programme (NTEP). The fragility of the TB control ecosystem in India was exposed, particularly in areas requiring specialized care and diagnostics. The partial recovery through 2023 signals resilience but also underlines persistent service gaps. To mitigate future disruptions, India must prioritize building a resilient health system by ensuring robust surveillance mechanisms capable of operating during crises, integrating TB and COVID-19 services particularly in areas of screening and diagnostics\u0026mdash;and securing sustained funding for TB programs and diagnostic infrastructure. Special attention should be given to protecting vulnerable subpopulations such as children, patients with drug-resistant TB (DR-TB), and people living with HIV (PLHIV). Furthermore, enhancing community engagement and reducing stigma are critical for improving care-seeking behaviour. Adopting a syntomic approach that acknowledges the complex interplay between TB, COVID-19, and broader social determinants of health will be crucial for designing inclusive and effective TB control strategies in the post-pandemic landscape.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eCOVID-19 pandemic severely disrupted TB notification trends in India, with the most significant decline in 2020, reflecting weakened surveillance, detection, and reporting systems. The resulting underdiagnosis and delayed treatment pose serious risks for increased transmission and disease burden. Strengthening TB monitoring, expanding active case finding, and investing in digital and community-based interventions are essential to restore services and prevent long-term setbacks.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthical approval:\u003c/h2\u003e\u003cp\u003eThe study did not require institutional review as the data used were already publicly accessible.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eDeclaration of interests:\u003c/h2\u003e\u003cp\u003eThe authors state that there are no competing interests associated with the content of this manuscript. PKS and ANK have no financial, personal, or professional affiliations that might be seen as influencing the findings of this study. This research was undertaken independently and was not influenced by any commercial or financial organisations that could pose a conflict of interest. All opinions expressed are those of the authors alone.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNo financial support was received by the authors for the conduct of this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003ePKS was responsible for the conception, design, data collection, data analysis, interpretation of results, and drafting of the manuscript. ANK contributed by reviewing and providing critical feedback on the manuscript for intellectual content and accuracy.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used in this study are publicly available from the sources cited in the manuscript. Indicators, including TB-HIV co-infection, extrapulmonary TB, rifampicin-resistant TB, household contacts, RR-TB among notified pulmonary TB, TB deaths (all forms), TB deaths excluding HIV, and TB deaths among HIV-positive cases were obtained from the WHO estimates dataset, accessible through the [ [Global Programme on Tuberculosis \u0026amp;amp; Lung Health](https:/www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/data) ]. Additional indicators such as TB incidence, bacteriologically confirmed pulmonary TB, notification of all TB cases, notification of paediatric TB cases, and MDR/RR-TB patients detected were extracted from the India TB Reports, available as referenced PDF documents via direct web links [ [Annual Reports \u0026ndash; Central Tuberculosis Division](https:/tbcindia.mohfw.gov.in/annual-reports) ]. All details have been cited in the Data Source section (citations 16\u0026ndash;22), with the corresponding file names and links listed in the Reference section: 16. Central TB Division. (2013). TB-India-2013.pdf17. Central TB Division. (2014). AU1023.pdf18. Central TB Division. (2018). TB-India-Report-2018.pdf19. Central TB Division. (2022). TBAnnualReport2022.pdf20. Central TB Division. (2024). TB-Report_for-Web_08_10-2024-1.pdf21. India achieved record TB notification in 2023 \u0026ndash; The Hindu22. Global Programme on Tuberculosis \u0026amp; Lung Health\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Global Tuberculosis Report 2023. Geneva: WHO; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Lancet. India's COVID-19 Emergency. Lancet. 2021;397(10286):1683.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCentral TB, Division. India TB Report 2023. Ministry of Health and Family Welfare, Government of India; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhargava A, Shewade HD. The potential impact of the COVID-19 response on tuberculosis in high-burden countries: a modelling analysis. Stop TB Partnership; 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Global Tuberculosis Report 2022. Geneva: WHO; 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCentral TB, Division. India TB Report 2021. Ministry of Health and Family Welfare, Government of India; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2021). The impact of the COVID-19 pandemic on TB detection and mortality in 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHogan AB, Jewell BL, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Global Health. 2020;8(9):e1132\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNikshay Portal. National TB Case Notification Reports. India: Central TB Division; 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCentral TB, Division. India TB Report 2022. Ministry of Health and Family Welfare, Government of India; 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCilloni L, Fu H, Vesga JF, et al. The potential impact of the COVID-19 pandemic on the tuberculosis epidemic: a modelling analysis. EClinicalMedicine. 2020;28:100603.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStop TBP. (2020). \u003cem\u003eThe potential impact of the COVID-19 response on tuberculosis in high-burden countries: A modelling analysis\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO. \u003cem\u003eGlobal Tuberculosis Report 2021\u003c/em\u003e.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240037021\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240037021\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStop TB, Partnership. \u003cem\u003eThe devastating effect of the COVID-19 pandemic on the TB response \u0026ndash; a global analysis\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.stoptb.org\u003c/span\u003e\u003cspan address=\"https://www.stoptb.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO. \u003cem\u003eImpact of COVID-19 on TB services\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/tuberculosis\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/tuberculosis\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCentral TB, Division. (2013). \u003cem\u003eTB-India-2013.pdf\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCentral TB, Division. (2014). \u003cem\u003eAU1023.pdf\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCentral TB, Division. (2018). \u003cem\u003eTB-India-Report-2018.pdf\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCentral TB, Division. (2022). \u003cem\u003eTBAnnualReport2022.pdf\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCentral TB, Division. (2024). \u003cem\u003eTB-Report_for-Web_08_10-2024-1.pdf\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u003cem\u003eIndia achieved record TB notification in 2023\u003c/em\u003e \u0026ndash; The Hindu.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGlobal Programme on Tuberculosis. \u0026amp; Lung Health.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tuberculosis (TB), COVID-19 pandemic, Interrupted Time-Series Analysis, Health service disruption, TB trends","lastPublishedDoi":"10.21203/rs.3.rs-7495327/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7495327/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eTo assess the impact of the COVID-19 pandemic on key TB indicators in India by comparing TB notification performance before and during the pandemic, and to inform strategies for integrating TB services into emergency preparedness and strengthening health system resilience.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study analysed 13 critical TB indicators, such as incidence, case notifications, drug resistance, and TB-related mortality, using data from the India TB Report and WHO estimates. An interrupted time-series analysis and linear generalised estimating equations were conducted to evaluate the impact of COVID-19 on TB trends by comparing the pre-pandemic period (2000\u0026ndash;2019) with the pandemic period (2020\u0026ndash;2023), capturing immediate disruptions and long-term changes in public primary healthcare indicators.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe study observed substantial disruption in TB-related notifications during the pandemic, with the most pronounced impact in 2020. Though notifications gradually improved, most remained below pre-pandemic levels by 2023. Significant reductions were noted in TB incidence (up to 18.6%), total TB cases (up to 53%), and paediatric TB (up to 45%). Notifications of drug-resistant forms of RR-TB and MDR/RR-TB declined by up to 36.6% and 34.2%, respectively. Post-pandemic increases were seen in TB-HIV co-infection, extrapulmonary TB, and rifampicin-resistant TB (up to 34.6%). TB-related mortality surged, with all forms of TB deaths rising by 85.6% and HIV-associated TB deaths increasing by nearly 97% in 2020 alone.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eCOVID-19 sharply disrupted TB notifications in India. Despite partial recovery, indicators remain below pre-pandemic levels. Strengthening TB programs and building resilient health systems is vital to ensure continuity of care during health emergencies.\u003c/p\u003e","manuscriptTitle":"From Progress to Disruption: Unveiling the Hidden Impact of COVID-19 on Tuberculosis Indicators in India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-24 02:16:08","doi":"10.21203/rs.3.rs-7495327/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-19T18:16:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103978794564488486452910357022593613020","date":"2025-10-18T07:56:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282929392291520897483230679102823530136","date":"2025-10-09T17:52:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T12:24:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-07T14:31:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-08T08:12:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-08T06:29:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-09-08T06:22:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a77395ae-2265-472f-a91b-c105441baaaa","owner":[],"postedDate":"October 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-24T02:16:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-24 02:16:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7495327","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7495327","identity":"rs-7495327","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}