Project 460451

Prior to the COVID-19 pandemic, tuberculosis (TB) was the world's leading infectious disease killer. TB remains a substantial health burden in Ontario, with over 600 annual cases reported. Not only are marginalized populations the most likely to be infected with TB, the economic burden of TB is also likely to be more severe due to socioeconomic status and labour market roles. TB care and burden has changed during the COVID-19 pandemic; COVID-19 restrictions have presented a risk of delayed TB diagnosis and treatment. These delays facilitate transmission of TB in the community and may increase the health and economic burden of TB. In Ontario, we do not yet have a good understanding of how access to TB care has been impacted by COVID-19 from the patient perspective, or the economic burden of TB, specifically as it relates to equity relevant characteristics. Our overall goal is to describe the TB patient experience during COVID-19 and to characterize the societal and health system costs of TB in Ontario, with a focus on equity. We will conduct patient interviews and administer patient cost-questionnaires to adults currently in treatment for TB disease and conduct a health system cost analysis using health administrative data and expert interviews. In all three studies we will apply an equity framework (Cochran's PROGRESS) to illuminate inequities in health opportunities and outcomes across relevant variables (e.g., sex/gender, race/ethnicity/culture). TB during the COVID-19 pandemic presents an important priority area for policy making as an opportunity to expand COVID-19 public health measures and government programs (e.g., CERB) to TB patients who would benefit greatly. Our work will provide timely and high-quality evidence on the healthcare and societal economic burden of TB as well as inequities in access to care to equip decision-makers with the information they need to plan and implement policies to best support adults with TB disease.