**5. Conclusions**

Using strengthened monthly real-time surveillance in 18 health facilities in Nairobi, Kenya, the number of people with presumptive TB and registered TB, as well as the number of people presenting for HIV testing, declined during 12 months of the COVID-19 outbreak compared with 12 months pre-COVID-19. Successful TB treatment and referral of HIVpositive persons to ART increased slightly during the COVID-19 period. Programmatic interventions on the ground were associated with an improvement in case detection and treatment outcomes in the second six months of the COVID-19 period compared to the first six months. This study strongly suggests that real-time operational research can generate useful evidence for real-time action.

**Author Contributions:** Conceptualization, I.M., P.T., J.M.C., E.O., P.O., N.C.N., A.M.V.K., S.S., H.D.S., M.K., R.Z., I.D.R., S.D.B., A.D.H.; methodology, I.M., P.T., J.M.C., E.O., P.O., N.C.N., A.M.V.K., S.S., H.D.S., M.K., R.Z., I.D.R., S.D.B., A.D.H.; software, P.T.; validation, I.M., P.T.; formal analysis, I.M., P.T., J.M.C., E.O., P.O., N.C.N., A.M.V.K., S.S., H.D.S., M.K., R.Z., I.D.R., S.D.B., A.D.H.; investigation, I.M., P.T.; resources, I.D.R.; data curation, I.M., P.T., A.D.H.; writing—original draft preparation, I.M., P.T., S.D.B., A.D.H.; writing—review and editing, I.M., P.T., J.M.C., E.O., P.O., N.C.N., A.M.V.K., S.S., H.D.S., M.K., R.Z., I.D.R., S.D.B., A.D.H.; visualization, I.M., P.T., S.D.B., A.D.H.; supervision, I.M., P.T., A.D.H.; project administration, S.D.B.; funding acquisition, S.D.B., 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> with Vital Strategies and Resolve to Save Lives Initiative, New York, USA. The gran<sup>t</sup> number is 78941.

**Institutional Review Board Statement:** The project received ethics approval from the Kenya Medical Research Institute (KEMRI/RES/7/3/1) and 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 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 18 health facilities with their help in collecting the data.

**Conflicts of Interest:** The authors declare no conflict of interests. 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.
