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

BACKGROUND: The COVID-19 pandemic disrupted TB services and case notifications worldwide, but disaggregated analyses are needed to identify inequities in post-pandemic recovery. METHODS: 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. RESULTS: 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. CONCLUSION: National recovery masked persistent subgroup inequities, highlighting the need for disaggregated surveillance to guide equitable TB control after major health system shocks.