The Impact of the COVID-19 Pandemic on Tuberculosis Treatment for Migrant Workers in Shanghai, China

Background: Tuberculosis (TB) is one of the world's top infectious killers, particularly affecting poor and vulnerable populations. COVID-19, another severe acute respiratory syndrome, is raging worldwide and has a relatively negative impact on TB care and patients. Thus, investigating the impact of COVID-19 on migrant TB patients is crucial. Objectives: The primary aim is to investigate and compare TB patients' health service conditions of migrant workers and residents before and during COVID-19. Besides, the study also investigates health system responses and constraints in TB control in the context of the COVID-19 pandemic in China and further develops evidence-based recommendations to tackle TB healthcare challenges facing the vulnerable group and to improve TB healthcare equality in China and beyond. Methods: This mixed-methods study applied quantitative analysis and qualitative analysis. The quantitative analysis used the TB registry data from 2018 to 2020 in Shanghai to study changes in the diagnosis delay, diagnosis results, treatment outcomes, and treatment periods by conducting descriptive statistics and regression analysis. The qualitative study conducted key informant interviews and focus group discussions on understanding TB-related policies, practices, and patient experience during the COVID-19 pandemic, especially for migrant TB patients. Results: Migrant patients have a longer diagnosis delay than local patients (95% CI: 1.62, 2.76), and there is a relatively short diagnosis delay for patients registered during the recovery period (95% CI: -2.15, -0.77). There is no significant difference between local and migrant patients or patients registered at different periods on test results (p-values > 0.05). The migrant patients are more likely to receive a successful or complete treatment during pre-COVID and the outbreak period than local patients, while the recovery period affects migrant patients' success treatment odds ratio and turns it down from 1.57 to 0.83. Migrant patients have a longer treatment period than local patients (95% CI: 5.94, 13.18), while registration time has no impact on the length of treatment. Qualitative results showed that Shanghai has a well-established policy structure on TB care and rapidly emerged new coping strategies during COVID-19. The pandemic positively impacted the TB diagnosis but negatively affected the TB treatment provision and access and patients' financial burden. Conclusion: Shanghai's mature policy and management system and its rapid response during the COVID-19 outbreak have resulted in no significant differences in TB diagnosis, treatment, and management between local and migrant patients. Also, the COVID-19 somehow positively affects the case detection but causes a certain degree of delay in treatment. The current reimbursement mechanism does not provide sufficient protection and support for migrant patients in terms of financial burden. However, more evidence is needed to test and elucidate this relationship.