**5. Conclusions**

Using strengthened monthly real-time surveillance in eight health facilities in Lilongwe, Malawi, numbers of persons with presumptive TB and registered TB, as well as numbers tested for HIV, declined during 12-months of the COVID-19 outbreak compared with 12-months pre-COVID-19. Successful TB treatment outcomes and the referral of HIVpositive persons to ART were maintained at high levels, with COVID-19 having hardly any negative impact. Unfortunately, declining trends in TB and HIV case detection were not redressed with real-time monthly surveillance. Suggestions have been made as to how to restore TB case detection and HIV testing so that TB- and HIV-related mortality can be kept as low as possible during this difficult period.

**Author Contributions:** Conceptualization, P.T., H.T., S.P., J.M., T.K., A.M.V.K., S.S., H.D.S., M.K., R.Z., I.D.R., S.D.B., and A.D.H.; methodology, P.T., H.T., S.P., J.M., T.K., A.M.V.K., S.S., H.D.S., M.K., R.Z., I.D.R., S.D.B., and A.D.H.; software, P.T.; validation, P.T. and H.T.; formal analysis, P.T., H.T., S.P., J.M., T.K., A.M.V.K., S.S., H.D.S., M.K., R.Z., I.D.R., S.D.B., and A.D.H.; investigation, P.T. and H.T.; resources, I.D.R.; data curation, P.T., H.T., and A.D.H.; writing—original draft preparation, P.T., H.T., S.D.B., and A.D.H.; writing—review and editing, P.T., H.T., S.P., J.M., T.K., A.M.V.K., S.S., H.D.S., M.K., R.Z., I.D.R., S.D.B., and A.D.H.; visualization, P.T., H.T., S.D.B., and A.D.H.; supervision, P.T., H.T., and A.D.H.; project administration, S.D.B.; funding acquisition, S.D.B. and A.D.H. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by Bloomberg Philanthropies through a gran<sup>t</sup> (grant number 78941) with Vital Strategies and the Resolve to Save Lives Initiative, New York, NY, USA.

**Institutional Review Board Statement:** The Malawi National Health Sciences Research Committee reviewed the protocol and exempted it from scientific and ethical review as they considered it to be a review of national programme data (MED/4/36c). The project received ethics approval from the Ethics Advisory Group of the International Union Against Tuberculosis and Lung Disease (EAG 33/2020). As no names or other means of identifying patients during data collection were recorded and as only aggregated data were used for the study, the need for informed patient consent was waived.

**Informed Consent Statement:** No names or other means of identifying patients during data collection were recorded, and only aggregated data were used for the study. Thus, the need for informed patient consent was waived by both of the ethics committees.

**Data Availability Statement:** The data that support the findings of the study are available from one of the first authors (P.T.) upon reasonable request.

**Acknowledgments:** The authors thank established staff working in TB and HIV control in the eight health facilities for their help in collecting the data.

**Conflicts of Interest:** The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
