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Deng H, Liu Y, Lv F, Li X, Qi M, Bo Y, Qiu S, He X, Ji F, Zeng QL, Gao N. Sex disparities of the effect of the COVID-19 pandemic on mortality among patients living with tuberculosis in the United States. Front Public Health 2024; 12:1413604. [PMID: 38957204 PMCID: PMC11217309 DOI: 10.3389/fpubh.2024.1413604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
Background We aimed to determine the trend of TB-related deaths during the COVID-19 pandemic. Methods TB-related mortality data of decedents aged ≥25 years from 2006 to 2021 were analyzed. Excess deaths were estimated by determining the difference between observed and projected mortality rates during the pandemic. Results A total of 18,628 TB-related deaths were documented from 2006 to 2021. TB-related age-standardized mortality rates (ASMRs) were 0.51 in 2020 and 0.52 in 2021, corresponding to an excess mortality of 10.22 and 9.19%, respectively. Female patients with TB demonstrated a higher relative increase in mortality (26.33 vs. 2.17% in 2020; 21.48 vs. 3.23% in 2021) when compared to male. Female aged 45-64 years old showed a surge in mortality, with an annual percent change (APC) of -2.2% pre-pandemic to 22.8% (95% CI: -1.7 to 68.7%) during the pandemic, corresponding to excess mortalities of 62.165 and 99.16% in 2020 and 2021, respectively; these excess mortality rates were higher than those observed in the overall female population ages 45-64 years in 2020 (17.53%) and 2021 (33.79%). Conclusion The steady decline in TB-related mortality in the United States has been reversed by COVID-19. Female with TB were disproportionately affected by the pandemic.
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Affiliation(s)
- Huan Deng
- National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yishan Liu
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fan Lv
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, China
| | - Xiaofeng Li
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Center for Infectious Diseases, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Mingyan Qi
- Department of Clinical Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yajing Bo
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sikai Qiu
- Department of Clinical Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinyuan He
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fanpu Ji
- National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Provincial Research Center, Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi'an, China
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
| | - Qing-Lei Zeng
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ning Gao
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Mashuri YA, Boettiger D, Wahyuningtias SD, Negara SNS, Subronto YW, Liverani M, Wulandari LPL, Ahmad RA, Thabrany H, Fardousi N, Kaldor J, Probandari A, Wiseman V. "I pity the TB patient": a mixed methods study assessing the impact of the COVID-19 pandemic on TB services in two major Indonesian cities and distilling lessons for the future. BMJ Glob Health 2024; 9:e014943. [PMID: 38760026 PMCID: PMC11103193 DOI: 10.1136/bmjgh-2023-014943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/20/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION In Indonesia, a country with around 280 million people and the second-highest tuberculosis (TB) incidence rate in the world, the impact of the COVID-19 pandemic on TB care needs careful assessment so that future response strategies can be strengthened. We conducted a study comparing TB testing and treatment rates before and during the first 2 years of the COVID-19 pandemic in Indonesia, and the reasons for any disruptions to care. METHODS We conducted retrospective secondary data analysis and qualitative interviews in Yogyakarta and Bandung, Indonesia. Routine data on TB testing and treatment were sourced from the national TB information system operated by the Indonesian Ministry of Health. TB testing and treatment outcomes were compared between two time periods: pre-COVID (2018-19); and during COVID-19 (2020-21). In-depth interviews were conducted with patients and health workers to explore their experiences in accessing and providing TB services during the pandemic. RESULTS There was a 45% (21 937/39 962) reduction in the number of patients tested for TB during the pandemic compared with pre-COVID-19, while the proportion of TB tests returning a positive result increased from 12% (4733/39 962) to 50% (10 945/21 937). The proportion of TB patients completing treatment increased by 2.6% during the pandemic, yet the proportion cured and the number of patients successfully treated both decreased (by 7% and 4.4%, respectively). Our qualitative interviews highlighted several factors influencing TB service access and delivery, including fear of being diagnosed with COVID-19 during TB-related clinic visits, fear of COVID-19 exposure among patients and health workers, healthcare facilities prioritising COVID-19 over other services, and mandatory mobility restrictions affecting both patients and health workers. CONCLUSION The COVID-19 pandemic impacted TB testing and treatment outcomes in Bandung and Yogyakarta. Policymakers should consider these findings in designing strategies to ensure TB services are maintained and supported during future health crises.
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Affiliation(s)
- Yusuf Ari Mashuri
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - David Boettiger
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Siska Dian Wahyuningtias
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Srila Nirmithya Salita Negara
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yanri Wijayanti Subronto
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Riris Andono Ahmad
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Biostatistics, Epidemiology, and Population Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Nasser Fardousi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ari Probandari
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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3
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Semnani K, Sohrabi M, Alavijeh PE, SeyedAlinaghi S, Esmaeili S, Halabchi F, Alizadeh Z, Salami A, Khaneshan AS. Prior COVID-19 infection among newly diagnosed tuberculosis patients in a tertiary care center in Tehran: A case-control study. Immun Inflamm Dis 2024; 12:e1275. [PMID: 38804889 PMCID: PMC11131933 DOI: 10.1002/iid3.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/14/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To assess the risk of developing pulmonary tuberculosis (TB) in accordance with prior history of COVID-19 infection. BACKGROUND Since the advent of the COVID-19 pandemic much discussion has been had on the possible role it might play on global efforts to combat TB; most, focusing on the pandemic's impact on health care systems' capabilities to manage TB cases. Mechanisms have also been proposed by which the COVID-19 infection may directly affect individuals' chance of developing TB infection. Cases have been reported with a history of COVID-19 infection preceding a diagnosis of TB, evidencing its possible role as a risk factor for the disease. METHODS A case-control study was conducted enrolling patients diagnosed with pulmonary TB in the absence of major risk factors previous history of TB, (HIV) human immunodeficiency virus infection), end-stage renal disease, organ transplants, and use of immunosuppressive agents) for developing TB. Each patient was age and sex matched with one healthy control. Data regarding prior COVID-19 infection, diabetes, and smoking status as well as the use of corticosteroids and Tocilizumab for the treatment of COVID-19 infection was obtained. Bivariate analysis was conducted and variables with a likely association with TB status were entered in a multivariate model. RESULTS Bivariate analysis demonstrated a significant relationship between prior COVID-19 infection and TB (95% confidence interval = 1.1-22.8, odds ratio [OR] = 5). Among other variables the severity of COVID-19 infection was found to have a likely association with TB status (p = .125). In a multivariate model, prior COVID-19 infection per se, was not found to be significantly associated with TB (p = .12, OR = 4.5). CONCLUSIONS There seems to be an association between prior history of COVID-19 and a future diagnosis of TB partially linked to the severity of disease. The findings of the current study may serve as a basis for further studies to determine the need for and efficacy of measures to follow-up COVID-19 patients at an increased risk for developing TB.
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Affiliation(s)
- Kiavash Semnani
- Tehran University of Medical Sciences School of MedicineTehranIran
| | - Marjan Sohrabi
- Department of Infectious Diseases, Tehran University of Medical SciencesImam Khomeini Hospital Complex, Tohid SqureTehranIran
| | - Parvaneh Ebrahimi Alavijeh
- Department of Infectious Diseases, Tehran University of Medical SciencesArash Women's HospitalTehranIran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Tehran University of Medical SciencesIranian Institute for Reduction of High Risk BehaviorsTehranIran
| | - Shirin Esmaeili
- Tehran University of Medical Sciences School of MedicineTehranIran
| | - Farzin Halabchi
- Department of Sports and Exercise MedicineTehran University of Medical SciencesTehranIran
| | - Zahra Alizadeh
- Department of Sports and Exercise MedicineTehran University of Medical SciencesTehranIran
| | - Amir Salami
- Student Research CommitteeIran University of Medical Sciences School of Medicine, Hemmat HwyTehranIran
| | - Arezoo Salami Khaneshan
- Department of Infectious Diseases, Tehran University of Medical SciencesImam Khomeini Hospital Complex, Tohid SqureTehranIran
- Iranian Research Center for HIV/AIDS, Tehran University of Medical SciencesIranian Institute for Reduction of High Risk BehaviorsTehranIran
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Aiello A, Najafi-Fard S, Goletti D. Initial immune response after exposure to Mycobacterium tuberculosis or to SARS-COV-2: similarities and differences. Front Immunol 2023; 14:1244556. [PMID: 37662901 PMCID: PMC10470049 DOI: 10.3389/fimmu.2023.1244556] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb) and Coronavirus disease-2019 (COVID-19), whose etiologic agent is severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), are currently the two deadliest infectious diseases in humans, which together have caused about more than 11 million deaths worldwide in the past 3 years. TB and COVID-19 share several aspects including the droplet- and aerosol-borne transmissibility, the lungs as primary target, some symptoms, and diagnostic tools. However, these two infectious diseases differ in other aspects as their incubation period, immune cells involved, persistence and the immunopathological response. In this review, we highlight the similarities and differences between TB and COVID-19 focusing on the innate and adaptive immune response induced after the exposure to Mtb and SARS-CoV-2 and the pathological pathways linking the two infections. Moreover, we provide a brief overview of the immune response in case of TB-COVID-19 co-infection highlighting the similarities and differences of each individual infection. A comprehensive understanding of the immune response involved in TB and COVID-19 is of utmost importance for the design of effective therapeutic strategies and vaccines for both diseases.
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Affiliation(s)
| | | | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Ganesapillai M, Mondal B, Sarkar I, Sinha A, Ray SS, Kwon YN, Nakamura K, Govardhan K. The face behind the Covid-19 mask - A comprehensive review. ENVIRONMENTAL TECHNOLOGY & INNOVATION 2022; 28:102837. [PMID: 35879973 PMCID: PMC9299984 DOI: 10.1016/j.eti.2022.102837] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 05/07/2023]
Abstract
The threat of epidemic outbreaks like SARS-CoV-2 is growing owing to the exponential growth of the global population and the continual increase in human mobility. Personal protection against viral infections was enforced using ambient air filters, face masks, and other respiratory protective equipment. Available facemasks feature considerable variation in efficacy, materials usage and characteristic properties. Despite their widespread use and importance, face masks pose major potential threats due to the uncontrolled manufacture and disposal techniques. Improper solid waste management enables viral propagation and increases the volume of associated biomedical waste at an alarming rate. Polymers used in single-use face masks include a spectrum of chemical constituents: plasticisers and flame retardants leading to health-related issues over time. Despite ample research in this field, the efficacy of personal protective equipment and its impact post-disposal is yet to be explored satisfactorily. The following review assimilates information on the different forms of personal protective equipment currently in use. Proper waste management techniques pertaining to such special wastes have also been discussed. The study features a holistic overview of innovations made in face masks and their corresponding impact on human health and environment. Strategies with SDG3 and SDG12, outlining safe and proper disposal of solid waste, have also been discussed. Furthermore, employing the CFD paradigm, a 3D model of a face mask was created based on fluid flow during breathing techniques. Lastly, the review concludes with possible future advancements and promising research avenues in personal protective equipment.
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Affiliation(s)
- Mahesh Ganesapillai
- Mass Transfer Group, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Bidisha Mondal
- Mass Transfer Group, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Ishita Sarkar
- Mass Transfer Group, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Aritro Sinha
- Mass Transfer Group, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Saikat Sinha Ray
- Department of Urban and Environmental Engineering, Ulsan National Institute of Science and Technology, Republic of Korea
| | - Young-Nam Kwon
- Department of Urban and Environmental Engineering, Ulsan National Institute of Science and Technology, Republic of Korea
| | - Kazuho Nakamura
- Faculty of Engineering, Division of Material Science and Chemical Engineering, Yokohama National University, Tokiwadai, Yokohama, Kanagawa 240-8501, Japan
| | - K Govardhan
- Department of Micro and Nano-Electronics, School of Electronics Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
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Hildebrand RE, Chandrasekar SS, Riel M, Touray BJB, Aschenbroich SA, Talaat AM. Superinfection with SARS-CoV-2 Has Deleterious Effects on Mycobacterium bovis BCG Immunity and Promotes Dissemination of Mycobacterium tuberculosis. Microbiol Spectr 2022; 10:e0307522. [PMID: 36200898 PMCID: PMC9603897 DOI: 10.1128/spectrum.03075-22] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/19/2022] [Indexed: 01/04/2023] Open
Abstract
An estimated one-third of the world's population is infected with Mycobacterium tuberculosis, with the majority being vaccinated with Mycobacterium bovis BCG. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a threat, and we must understand how SARS-CoV-2 can modulate both BCG immunity and tuberculosis pathogenesis. Interestingly, neither BCG vaccination nor tuberculosis infection resulted in differences in clinical outcomes associated with SARS-CoV-2 in transgenic mice. Surprisingly, earlier M. tuberculosis infection resulted in lower SARS-CoV-2 viral loads, mediated by the heightened immune microenvironment of the murine lungs, unlike vaccination with BCG, which had no impact. In contrast, M. tuberculosis-infected tissues had increased bacterial loads and decreased histiocytic inflammation in the lungs following SARS-CoV-2 superinfection. SARS-CoV-2 modulated BCG-induced type 17 responses while decreasing type 1 and increasing type 2 cytokines in M. tuberculosis-infected mice. These findings challenge initial findings of BCG's positive impact on SARS-CoV-2 infection and suggest potential ramifications for M. tuberculosis reactivation upon SARS-CoV-2 superinfection. IMPORTANCE Prior to SARS-CoV-2, M. tuberculosis was the leading infectious disease killer, with an estimated one-third of the world's population infected and 1.7 million deaths a year. Here, we show that SARS-CoV-2 superinfection caused increased bacterial dissemination in M. tuberculosis-infected mice along with immune and pathological changes. SARS-CoV-2 also impacted the immunity of BCG-vaccinated mice, resulting in decreased interleukin-17 (IL-17) levels, while offering no protective effect against SARS-CoV-2. These results demonstrate that SARS-CoV-2 may have a deleterious effect on the ongoing M. tuberculosis pandemic and potentially limit BCG's efficacy.
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Affiliation(s)
- Rachel E. Hildebrand
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin—Madison, Madison, Wisconsin, USA
| | - Shaswath Sekar Chandrasekar
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin—Madison, Madison, Wisconsin, USA
| | - Mariah Riel
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin—Madison, Madison, Wisconsin, USA
| | - Bubacarr J. B. Touray
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin—Madison, Madison, Wisconsin, USA
| | - Sophie A. Aschenbroich
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin—Madison, Madison, Wisconsin, USA
| | - Adel M. Talaat
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin—Madison, Madison, Wisconsin, USA
- Pan Genome Systems, Madison, Wisconsin, USA
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7
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Mannan S, Oga-Omenka C, Soman ThekkePurakkal A, Huria L, Kalra A, Gandhi R, Kapoor T, Gunawardena N, Raj S, Kaur M, Sassi A, Pande T, Shibu V, Sarin S, Singh Chadha S, Heitkamp P, Das J, Rao R, Pai M. Adaptations to the first wave of the COVID-19 pandemic by private sector tuberculosis care providers in India. J Clin Tuberc Other Mycobact Dis 2022; 28:100327. [PMID: 35874450 PMCID: PMC9295336 DOI: 10.1016/j.jctube.2022.100327] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background India's dominant private healthcare sector is the destination for 60-85% of initial tuberculosis care-seeking. The COVID-19 pandemic in India drastically affected TB case notifications in the first half of 2020. In this survey, we assessed the impact of the first wave of COVID-19 in India on private providers, and changes they adopted in their practice due to the pandemic. Methods The Joint Effort for Elimination of TB (JEET) is a nationwide Global Fund project implemented across 406 districts in 23 states to extend quality TB services to patients seeking care in private sector. We conducted a rapid survey of 11% (2,750) of active providers engaged under JEET's intense Patient Provider Support Agency (PPSA) model across 15 Indian states in Q1 (February-March) of 2021. Providers were contacted in person or telephonically, and consenting participants were interviewed using a web-based survey tool. Responses from participants were elicited on their practice before COVID-19, during the 2020 lockdowns (March-April 2020) and currently (Q1 2021). Data were adjusted for survey design and non-response, and results were summarised using descriptive statistics and logistic regression. Results Of the 2,750 providers sampled, 2,011 consented and were surveyed (73 % response). Nearly 50 % were between 30 and 45 years of age, and 51 % were from Uttar Pradesh, Maharashtra and Gujarat. Seventy percent of providers reported reduced daily out-patient numbers in Q1 2021 compared to pre-COVID times. During the lockdown, 898 (40 %) of providers said their facilities were closed, while 323 (11 %) offered limited services including teleconsultation. In Q1 2021, 88 % of provider facilities were fully open, with 10 % providing adjusted services, and 4 % using teleconsultation. Only 2 % remained completely closed. Majority of the providers (92 %) reported not experiencing any delays in TB testing in Q1 2021 compared to pre-COVID times. Only 6 % reported raising costs at their clinic, mostly to cover personal protective equipment (PPE) and other infection control measures, although 60-90 % implemented various infection control measures. Thirty-three percent of TB providers were ordering COVID-19 testing, in addition to TB testing.To adapt, 82% of survey providers implemented social distancing and increased timing between appointments and 83% started conducting temperature checks, with variation by state and provider type, while 89% adopted additional sanitation measures in their facilities. Furthermore, 62% of providers started using PPE, and 13% made physical changes (air filters, isolation of patient areas) to their clinic to prevent infection. Seventy percent of providers stated that infection control measures could decrease TB transmission. Conclusion Although COVID-19 restrictions resulted in significant declines in patient turn-out at private facilities, our analysis showed that most providers were open and costs for TB care remained mostly the same in Q1 2021. As result of the COVID-19 pandemic, several positive strategies have been adapted by the private sector TB care providers. Since the subsequent COVID-19 waves were more severe or widespread, additional work is needed to assess the impact of the pandemic on the private health sector.
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Affiliation(s)
| | - Charity Oga-Omenka
- McGill International TB Centre, Montreal, Canada
- School of Public Health Sciences, University of Waterloo, Canada
| | | | - Lavanya Huria
- McGill International TB Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Aakshi Kalra
- Foundation for Innovative New Diagnostics (FIND), India
| | | | | | - Nathali Gunawardena
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Shekhar Raj
- Centre for Health Research and Innovation (CHRI), India
| | - Manjot Kaur
- TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Angelina Sassi
- McGill International TB Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Tripti Pande
- McGill International TB Centre, Montreal, Canada
| | | | - Sanjay Sarin
- Foundation for Innovative New Diagnostics (FIND), India
| | | | - Petra Heitkamp
- McGill International TB Centre, Montreal, Canada
- TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Raghuram Rao
- Central TB Division, Ministry of Health & Family Welfare, India
| | - Madhukar Pai
- McGill International TB Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
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