The impact of COVID-19 pandemic in tuberculosis diagnosis in sub-Saharan Africa: data from DREAM program in Mozambique

background: TB is a global emergency, COVID-19 reversed the trend in TB mortality reduction to 2017 levels. mozambique is one of the highest-burden countries with 368 new cases per 100.000 population in 2020.objectives: this analysis aims to evaluate a TB diagnostic service in two mozambican cities before and during the COVID-19 pandemic. methods: we reviewed routine activity data from two laboratories in mozambique (maputo and beira) in the period 01/2018–08/2022. geneXpert test was prescribed based on clinical suspicion. data about the number of tests, results, and rifampicin resistance were collected.Results: In the period 3,071 tests were conducted: 391 positive, and 32 rifampicin resistant. the number of positive samples was higher in Beira (20.2% vs 5%, OR 4[3.1-5.2]).In maputo, we observed a higher percentage of rifampicin-resistant samples (13.2%vs7%, OR 0.5[0.2-1.1]), but the overall prevalence of rifampicin resistance was higher in beira (14.1‰vs6.6‰, OR 2.1[1.0-4.5]).In 2020 and the first semester of 2021 a reduction in activity was observed, but positivity rates remained stable, with a slight increment starting in 2020.conclusions: our data confirm the impact of the COVID-19 pandemic on TB diagnostic services but also highlight possible benefits in terms of diagnostic appropriateness in clinical centers. keywords: COVID-19 pandemic; tuberculosis diagnosis; sub-saharan africa; mozambique.