**5. Conclusions**

Using strengthened monthly real-time surveillance in 10 health facilities in Harare, Zimbabwe, we documented that numbers of persons with presumptive PTB and registered TB, treatment outcomes of patients enrolled on treatment and numbers being HIV tested all declined during 12 months of the COVID-19 outbreak compared with 12 months pre-COVID-19. The referral of HIV-positive persons to ART also declined, although they were maintained at high levels throughout. Despite using the monthly data, the declining trends in TB and HIV services could not be reversed because of on-going restrictions resulting from the COVID-19 pandemic combined with industrial action in the health sector and the expiry of certain diagnostic reagents. Suggestions have been made as to how to restore TB case detection and HIV testing so that TB- and HIV-related morbidity and mortality can be kept as low as possible during this difficult period.

**Author Contributions:** Conceptualization, P.T., K.C.T., C.T., C.S., T.A., 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., K.C.T., C.T., C.S., T.A., 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 K.C.T.; formal analysis, P.T., K.C.T., C.T., C.S., T.A., 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., K.C.T. and C.T.; resources, I.D.R.; data curation, P.T., K.C.T. and A.D.H.; writing—original draft preparation, P.T., K.C.T., C.T., S.D.B. and A.D.H.; writing—review and editing, P.T., K.C.T., C.T., C.S., T.A., 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., K.C.T., C.T., S.D.B. and A.D.H.; supervision, P.T., K.C.T., C.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> with Vital Strategies and the Resolve to Save Lives Initiative, New York, NY, USA.

**Institutional Review Board Statement:** The project received ethics approval from the Medical Research Council of Zimbabwe (MRCZ/E/273) 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 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 ten 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.
