Unequal recovery of TB notifications after COVID-19 in Colombia, 2018-2022

The COVID-19 pandemic disrupted TB services and case notifications worldwide, but disaggregated analyses are needed to identify inequities in post-pandemic recovery.

We analysed national TB surveillance data from Colombia (January 2018-November 2022) using interrupted time-series models. Monthly notification rates were estimated overall and by sex, age, health insurance scheme, area of residence, and indigenous status. Models quantified the immediate change in March 2020, post-interruption trend changes, and divergence from counterfactual rates projected from pre-pandemic trends.

National notification rates fell by 17.1 cases per million in March 2020, a 45.0% reduction relative to expected values. Notifications subsequently increased and by November 2022 exceeded counterfactual projections by 13.2%. Disaggregated analyses showed heterogeneous recovery. Rates were 19.3% above expected among men versus 3.0% among women, and 13.1% among adults aged ≥15 years versus 4.0% among children aged <15 years. Notifications in the subsidised insurance scheme were ∼26% above expected, whereas those in the contributory scheme remained below expected. Urban rates exceeded projections, while rates for indigenous men remained below.

National recovery masked persistent subgroup inequities, highlighting the need for disaggregated surveillance to guide equitable TB control after major health system shocks.