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Marco MH, Ahmedov S, Castro KG. The global impact of COVID-19 on tuberculosis: A thematic scoping review, 2020-2023. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003043. [PMID: 38959278 PMCID: PMC11221697 DOI: 10.1371/journal.pgph.0003043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND This thematic scoping review of publications sought to understand the global impact of COVID-19 on tuberculosis (TB), interpret the scope of resonating themes, and offer policy recommendations to stimulate TB recovery and future pandemic preparedness. DATA SOURCES Publications were captured from three search engines, PubMed, EBSCO, and Google Scholar, and applicable websites written in English from January 1, 2020, to April 30, 2023. STUDY SELECTION Our scoping review was limited to publications detailing the impact of COVID-19 on TB. Original research, reviews, letters, and editorials describing the deleterious and harmful--yet sometimes positive--impact of COVID-19 (sole exposure) on TB (sole outcome) were included. The objective was to methodically categorize the impacts into themes through a comprehensive review of selected studies to provide significant health policy guidance. DATA EXTRACTION Two authors independently screened citations and full texts, while the third arbitrated when consensus was not met. All three performed data extraction. DATA SYNTHESIS/RESULTS Of 1,755 screened publications, 176 (10%) covering 39 countries over 41 months met the inclusion criteria. By independently using a data extraction instrument, the three authors identified ten principal themes from each publication. These themes were later finalized through a consensus decision. The themes encompassed TB's care cascade, patient-centered care, psychosocial issues, and health services: 1) case-finding and notification (n = 45; 26%); 2) diagnosis and laboratory systems (n = 19; 10.7%) 3) prevention, treatment, and care (n = 22; 12.2%); 4) telemedicine/telehealth (n = 12; 6.8%); 5) social determinants of health (n = 14; 8%); 6) airborne infection prevention and control (n = 8; 4.6%); 7) health system strengthening (n = 22; 13%); 8) mental health (n = 13; 7.4%); 9) stigma (n = 11; 6.3%); and 10) health education (n = 10; 5.7%). LIMITATIONS Heterogeneity of publications within themes. CONCLUSIONS We identified ten globally generalizable themes of COVID-19's impact on TB. The impact and lessons learned from the themed analysis propelled us to draft public health policy recommendations to direct evidence-informed guidance that strengthens comprehensive global responses, recovery for TB, and future airborne pandemic preparedness.
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Affiliation(s)
- Michael H. Marco
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
- Global Health Technical Assistance and Mission Support, Vienna, Virginia, United States of America
| | - Sevim Ahmedov
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Kenneth G. Castro
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
- Rollins School of Public Health, School of Medicine, Emory/Georgia TB Research Advancement Center, Atlanta, Georgia, United States of America
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Baker PJ, Amaral EP, Castro E, Bohrer AC, Torres-Juárez F, Jordan CM, Nelson CE, Barber DL, Johnson RF, Hilligan KL, Mayer-Barber KD. Co-infection of mice with SARS-CoV-2 and Mycobacterium tuberculosis limits early viral replication but does not affect mycobacterial loads. Front Immunol 2023; 14:1240419. [PMID: 37720210 PMCID: PMC10502726 DOI: 10.3389/fimmu.2023.1240419] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Viral co-infections have been implicated in worsening tuberculosis (TB) and during the COVID-19 pandemic, the global rate of TB-related deaths has increased for the first time in over a decade. We and others have previously shown that a resolved prior or concurrent influenza A virus infection in Mycobacterium tuberculosis (Mtb)-infected mice resulted in increased pulmonary bacterial burden, partly through type I interferon (IFN-I)-dependent mechanisms. Here we investigated whether SARS-CoV-2 (SCV2) co-infection could also negatively affect bacterial control of Mtb. Importantly, we found that K18-hACE2 transgenic mice infected with SCV2 one month before, or months after aerosol Mtb exposure did not display exacerbated Mtb infection-associated pathology, weight loss, nor did they have increased pulmonary bacterial loads. However, pre-existing Mtb infection at the time of exposure to the ancestral SCV2 strain in infected K18-hACE2 transgenic mice or the beta variant (B.1.351) in WT C57Bl/6 mice significantly limited early SCV2 replication in the lung. Mtb-driven protection against SCV2 increased with higher bacterial doses and did not require IFN-I, TLR2 or TLR9 signaling. These data suggest that SCV2 co-infection does not exacerbate Mtb infection in mice, but rather the inflammatory response generated by Mtb infection in the lungs at the time of SCV2 exposure restricts viral replication.
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Affiliation(s)
- Paul J. Baker
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Eduardo P. Amaral
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Ehydel Castro
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Andrea C. Bohrer
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Flor Torres-Juárez
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Cassandra M. Jordan
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Christine E. Nelson
- T Lymphocyte Biology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, United States
| | - Daniel L. Barber
- T Lymphocyte Biology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, United States
| | - Reed F. Johnson
- SARS-CoV-2 Virology Core, Laboratory of Viral Diseases, NIAID, NIH, Bethesda, MD, United States
| | - Kerry L. Hilligan
- Immunobiology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, United States
| | - Katrin D. Mayer-Barber
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
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3
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Ledesma JR, Basting A, Chu HT, Ma J, Zhang M, Vongpradith A, Novotney A, Dalos J, Zheng P, Murray CJL, Kyu HH. Global-, Regional-, and National-Level Impacts of the COVID-19 Pandemic on Tuberculosis Diagnoses, 2020-2021. Microorganisms 2023; 11:2191. [PMID: 37764035 PMCID: PMC10536333 DOI: 10.3390/microorganisms11092191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Evaluating cross-country variability on the impact of the COVID-19 pandemic on tuberculosis (TB) may provide urgent inputs to control programs as countries recover from the pandemic. We compared expected TB notifications, modeled using trends in annual TB notifications from 2013-2019, with observed TB notifications to compute the observed to expected (OE) ratios for 170 countries. We applied the least absolute shrinkage and selection operator (LASSO) method to identify the covariates, out of 27 pandemic- and tuberculosis-relevant variables, that had the strongest explanatory power for log OE ratios. The COVID-19 pandemic was associated with a 1.55 million (95% CI: 1.26-1.85, 21.0% [17.5-24.6%]) decrease in TB diagnoses in 2020 and a 1.28 million (0.90-1.76, 16.6% [12.1-21.2%]) decrease in 2021 at a global level. India, Indonesia, the Philippines, and China contributed the most to the global declines for both years, while sub-Saharan Africa achieved pre-pandemic levels by 2021 (OE ratio = 1.02 [0.99-1.05]). Age-stratified analyses revealed that the ≥ 65-year-old age group experienced greater relative declines in TB diagnoses compared with the under 65-year-old age group in 2020 (RR = 0.88 [0.81-0.96]) and 2021 (RR = 0.88 [0.79-0.98]) globally. Covariates found to be associated with all-age OE ratios in 2020 were age-standardized smoking prevalence in 2019 (β = 0.973 [0.957-990]), school closures (β = 0.988 [0.977-0.998]), stay-at-home orders (β = 0.993 [0.985-1.00]), SARS-CoV-2 infection rate (β = 0.991 [0.987-0.996]), and proportion of population ≥65 years (β = 0.971 [0.944-0.999]). Further research is needed to clarify the extent to which the observed declines in TB diagnoses were attributable to disruptions in health services, decreases in TB transmission, and COVID-19 mortality among TB patients.
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Affiliation(s)
- Jorge R. Ledesma
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI 02912, USA
| | - Ann Basting
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Huong T. Chu
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
| | - Jianing Ma
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, 1800 Cannon Drive, Columbus, OH 43210, USA;
| | - Meixin Zhang
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Avina Vongpradith
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Amanda Novotney
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Jeremy Dalos
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
| | - Hmwe H. Kyu
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
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Sahu S, Nagtode N. Impact on Tuberculosis Notification During COVID-19 Pandemic in India: A Narrative Review. Cureus 2023; 15:e44087. [PMID: 37750132 PMCID: PMC10518063 DOI: 10.7759/cureus.44087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Various programs are being weakened due to the COVID-19 pandemic, and the tuberculosis (TB) program is no exception. TB case detection and notification is one of the worst affected areas. The study aims to assess India's TB reporting status during this pandemic and find possible solutions. Data analysis has been obtained from the India TB notification open-source database. Relevant literature research has been done to determine the measures based on various efforts made by different Indian states. There was a review of all TB notifications in 2019, 2020, and 2021 and a deficiency in notifications. Between 2019 and 2021, the country's TB notification ratio experienced a significant adaptation. In 2020, all states reported a decline in private and public TB case reports. In the nation, only a few private TB notifications were lost. In April 2020, there were the fewest notifications, which began to decline in February 2020. When states began implementing cutting-edge programs like the Integrated TB COVID Case Search and Active Case Finding (ACF), the notification trend improved in May 2020. The notifications of TB cases decreased significantly due to the present COVID-19 pandemic, which has consequences for the disease's stealthy spread throughout homes and communities. However, the situation may be better with an integrated strategy for managing TB-COVID cases.
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Affiliation(s)
- Sweta Sahu
- Epidemiology and Public Health, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikhilesh Nagtode
- Community Medicine, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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5
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Miller R, Wafula F, Eman KU, Rakesh PS, Faleye BO, Duggan C, Sousa Pinto G, Heitkamp P, Rana N, Klinton JS, Sulis G, Oga-Omenka C, Pai M. Pharmacy engagement in TB prevention and care: not if, but how? BMJ Glob Health 2023; 8:e013104. [PMID: 37474278 PMCID: PMC10360412 DOI: 10.1136/bmjgh-2023-013104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Rosalind Miller
- TBPPM Learning Network, Research Institute McGill University Health Center (RI-MUHC), Montreal, Quebec, Canada
| | - Francis Wafula
- Institute of Healthcare Management, Strathmore University Strathmore Business School, Nairobi, Kenya
| | | | - P S Rakesh
- Amity Institute of Public Health & Hospital Administration, Amity University, Noida, Uttar Pradesh, India
| | - Bolanle Olusola Faleye
- USAID Local Health Systems Sustainability project (LHSS), Abt Associates Nigeria, Lagos, Nigeria
| | - Catherine Duggan
- International Pharmaceutical Federation (FIP), The Hague, The Netherlands
| | | | - Petra Heitkamp
- TBPPM Learning Network, Research Institute McGill University Health Center (RI-MUHC), Montreal, Quebec, Canada
| | - Namrata Rana
- TBPPM Learning Network, Research Institute McGill University Health Center (RI-MUHC), Montreal, Quebec, Canada
| | - Joel Shyam Klinton
- TBPPM Learning Network, Research Institute McGill University Health Center (RI-MUHC), Montreal, Quebec, Canada
| | - Giorgia Sulis
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Charity Oga-Omenka
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Madhukar Pai
- McGill School of Population and Global Health, McGill University, Montreal, Quebec, Canada
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Oga-Omenka C, Sassi A, Vasquez NA, Baruwa E, Rosapep L, Daniels B, Olusola-Faleye B, Huria L, Adamu A, Johns B, Das J, Pai M. Tuberculosis service disruptions and adaptations during the first year of the COVID-19 pandemic in the private health sector of two urban settings in Nigeria-A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001618. [PMID: 36963094 PMCID: PMC10038269 DOI: 10.1371/journal.pgph.0001618] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
Nigeria has the second largest share of undiagnosed TB cases in the world and a large private health sector estimated to be the point of initial care-seeking for 67% of TB patients. There is evidence that COVID-19 restrictions disrupted private healthcare provision, but insufficient data on how private healthcare provision changed as a result of the pandemic. We conducted qualitative interviews and a survey to assess the impact of the pandemic, and government response on private healthcare provision, and the disruptions providers experienced, particularly for TB services. Using mixed methods, we targeted policymakers, and a network of clinical facilities, laboratories, community pharmacies, and medicine vendors in Kano and Lagos, Nigeria. We interviewed 11 policymakers, surveyed participants in 2,412 private facilities. Most (n = 1,676, 70%) facilities remained open during the initial lockdown period, and most (n = 1,667, 69%) offered TB screening. TB notifications dipped during the lockdown periods but quickly recovered. Clinical facilities reported disruptions in availability of medical supplies, staff, required renovations, patient volume and income. Few private providers (n = 119, 11% in Kano; n = 323, 25% in Lagos) offered any COVID-19 screening up to the time of the survey, as these were only available in designated facilities. These findings aligned with the interviews as policymakers reported a gradual return to pre-COVID services after initial disruptions and diversion of resources to the pandemic response. Our results show that COVID-19 and control measures had a temporary impact on private sector TB care. Although some facilities saw decreases in TB notifications, private facilities continued to provide care for individuals with TB who otherwise might have been unable to seek care in the public sector. Our findings highlight resilience in the private sector as they recovered fairly quickly from pandemic-related disruptions, and the important role private providers can play in supporting TB control efforts.
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Affiliation(s)
- Charity Oga-Omenka
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- McGill International TB Centre, Montreal, Canada
| | - Angelina Sassi
- McGill International TB Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | | | - Elaine Baruwa
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, Nigeria
| | - Lauren Rosapep
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, Nigeria
| | - Benjamin Daniels
- School of Public Policy, Georgetown University, Washington, DC, United States of America
| | - Bolanle Olusola-Faleye
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, Nigeria
| | - Lavanya Huria
- McGill International TB Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Abdu Adamu
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, Nigeria
| | - Benjamin Johns
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, Nigeria
| | - Jishnu Das
- School of Public Policy, Georgetown University, Washington, DC, United States of America
| | - Madhukar Pai
- McGill International TB Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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Trajman A, Felker I, Alves LC, Coutinho I, Osman M, Meehan SA, Singh UB, Schwartz Y. The COVID-19 and TB syndemic: the way forward. Int J Tuberc Lung Dis 2022; 26:710-719. [PMID: 35898126 PMCID: PMC9341497 DOI: 10.5588/ijtld.22.0006] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Together, SARS-CoV-2 and M. tuberculosis have killed approximately 5.7 million people worldwide over the past 2 years. The COVID-19 pandemic, and the non-pharmaceutical interventions to mitigate COVID-19 transmission (including social distancing regulations, partial lockdowns and quarantines), have disrupted healthcare services and led to a reallocation of resources to COVID-19 care. There has also been a tragic loss of healthcare workers who succumbed to the disease. This has had consequences for TB services, and the fear of contracting COVID-19 may also have contributed to reduced access to TB services. Altogether, this is projected to have resulted in a 5-year setback in terms of mortality from TB and a 9-year setback in terms of TB detection. In addition, past and present TB disease has been reported to increase both COVID-19 fatality and incidence. Similarly, COVID-19 may adversely affect TB outcomes. From a more positive perspective, the pandemic has also created opportunities to improve TB care. In this review, we highlight similarities and differences between these two infectious diseases, describe gaps in our knowledge and discuss solutions and priorities for future research.
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Affiliation(s)
- A Trajman
- Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil, Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - I Felker
- WHO Collaborating Centre, Novosibirsk Tuberculosis Research Institute, Novosibirsk, Russian Federation
| | - L C Alves
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA
| | - I Coutinho
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, School of Human Sciences, Faculty of Education, Health & Human Sciences, University of Greenwich, London, UK
| | - S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - U B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Y Schwartz
- WHO Collaborating Centre, Novosibirsk Tuberculosis Research Institute, Novosibirsk, Russian Federation
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Calnan M, Moran A, Jassim AlMossawi H. Maintaining essential tuberculosis services during the COVID-19 pandemic, Philippines. Bull World Health Organ 2022; 100:127-134. [PMID: 35125537 PMCID: PMC8795840 DOI: 10.2471/blt.21.286807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To describe the implementation, use and cost of a phone-based tuberculosis case finding and case management intervention during the coronavirus disease 2019 (COVID-19) pandemic in two regions in the Philippines. Methods We implemented this phone-based intervention to maintain tuberculosis treatment support, active case finding and contact investigation efforts in 42 facilities, starting in June 2020. We established a dedicated mobile phone number for each centre and promoted the intervention on different media platforms. We recruited and trained staff members and provided them with tools for screening and patient follow-up. We collected data on tuberculosis screening, diagnosis and treatment initiation for this intervention and three comparator interventions over the same period. We collected data on number and type of calls placed and received. We estimated the additional cost of this intervention compared to the standard of care. Findings From October 2020 to September 2021, 14 tuberculosis contact centres, for which complete data were available, identified 43.5% (827/1901) of patients with bacteriologically confirmed tuberculosis enrolled in treatment among all comparator interventions. These centres managed 6187 calls over the same period. The additional cost of implementing and running the centre for 12 months was 398 United States dollars per facility. Conclusion The tuberculosis contact centre is a low-technology telehealth intervention which contributed to overall treatment initiation during the COVID-19 pandemic. Additional work should assess the extent to which the contact centre identifies tuberculosis patients previously missed by the health system, regardless of the pandemic.
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Affiliation(s)
- Marianne Calnan
- University Research Co., USAID TB Platforms for Sustainable Detection, Care and Treatment Project, Manila, Philippines
| | - Alexander Moran
- University Research Co., 5404 Wisconsin Ave, Suite 800, Chevy Chase, MD 20815, United States of America
| | - Hala Jassim AlMossawi
- University Research Co., 5404 Wisconsin Ave, Suite 800, Chevy Chase, MD 20815, United States of America
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Caren GJ, Iskandar D, Pitaloka DAE, Abdulah R, Suwantika AA. COVID-19 Pandemic Disruption on the Management of Tuberculosis Treatment in Indonesia. J Multidiscip Healthc 2022; 15:175-183. [PMID: 35115781 PMCID: PMC8801372 DOI: 10.2147/jmdh.s341130] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/11/2022] [Indexed: 12/26/2022] Open
Abstract
The current coronavirus disease 2019 (COVID-19) situation might deteriorate the efforts to eliminate tuberculosis (TB) in Indonesia. This study aimed to review the COVID-19 pandemic disruption on the management of TB treatment in Indonesia. We identified several disruptions due to the pandemic on TB control management. Firstly, there is a potential decrease in the funding for TB treatment. Financial disruptions caused by the COVID-19 pandemic have led to further setbacks. In many countries, including Indonesia, financial and other resources have been reallocated from TB to the COVID-19 response. Secondly, it has been highlighted that all TB services, including case detection and rapid diagnostic, have been disrupted by the pandemic. Thirdly, the pandemic would be associated with the lower quality of care and treatment for TB in Indonesia. It might decrease the enthusiasm of patients with TB, multi-drug resistant (MDR)-TB, and TB-human immunodeficiency virus (HIV) to visit TB hospitals because of social distancing measures by the government. Finally, the COVID-19 pandemic also has impacted critical activities of monitoring, evaluation, and surveillance. There are several lessons from other countries about managing TB treatment during the pandemic, such as combining screening for COVID-19 and TB by applying x-ray technology and artificial intelligence-based software. In addition, the use of telemedicine or telehealth in TB treatment is also beneficial to deliver medication, assess patients' progress, and inform prevention strategies. To reach the target with the end TB strategy, the government of Indonesia can adopt the World Health Organization's (WHO's) comprehensive strategies, such as integrated, patient-centered TB care and prevention strategies; bold policies and supportive systems; and intensified research and innovations.
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Affiliation(s)
- Gabriella J Caren
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Deni Iskandar
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
- Faculty of Pharmacy, Bhakti Kencana University, Bandung, Indonesia
| | - Dian A E Pitaloka
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, Indonesia
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10
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Raymond CB, Ward PR. Community-Level Experiences, Understandings, and Responses to COVID-19 in Low- and Middle-Income Countries: A Systematic Review of Qualitative and Ethnographic Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12063. [PMID: 34831831 PMCID: PMC8621360 DOI: 10.3390/ijerph182212063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 02/02/2023]
Abstract
(1) Background: COVID-19 disruptions offer researchers insight into how pandemics are at once biological and social threats, as communities struggle to construct meaning from novel challenges to their ontological status quo. Multiple epistemes, in which public health imperatives confront and negotiate locally derived knowledge and traditions, vie for legitimacy and agency, resulting in new cultural forms. (2) Methods: To investigate the context and construction of community responses, a systematic review of qualitative literature was conducted with the aim of evaluating those insights provided by empirical, social field research in low- and middle-income countries since the onset of COVID-19. Six scholarly databases were searched for empirical, qualitative, field-based, or participatory research that was published in peer-reviewed journals between December 2019 and August 2021. (3) Results: Twenty-five studies were selected for data extraction, following critical appraisal for methodological rigor by two independent reviewers, and were then analyzed thematically. Faced with unprecedented social ruptures, restrictions in social and physical mobility, and ever-looming uncertainties of infection, financial insecurity, stigma, and loss, communities worldwide reacted in multiple and complex ways. Pervasive misinformation and fear of social rejection resulted in noncompliance with pandemic sanctions, resistance, and increased isolation, allowing the spread of the disease. The meaning of, and understandings about, COVID-19 were constructed using traditional, religious, and biomedical epistemologies, which were occasionally in conflict with each other. Innovations and adaptations, through syntheses of traditional and biomedical discourses and practice, illustrated community resilience and provided models for successful engagement to improve public health outcomes. (4) Conclusion: Local context and community engagement were indispensable considerations when enacting effective public health interventions to meet the challenges of the pandemic.
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Affiliation(s)
- Christopher B. Raymond
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia;
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11
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Zimmer AJ, Klinton JS, Oga-Omenka C, Heitkamp P, Nawina Nyirenda C, Furin J, Pai M. Tuberculosis in times of COVID-19. J Epidemiol Community Health 2021; 76:310-316. [PMID: 34535539 PMCID: PMC8453591 DOI: 10.1136/jech-2021-217529] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022]
Abstract
The COVID-19 pandemic has caused widespread disruptions to tuberculosis (TB) care and service delivery in 2020, setting back progress in the fight against TB by several years. As newer COVID-19 variants continue to devastate many low and middle-income countries in 2021, the extent of this setback is likely to increase. Despite these challenges, the TB community can draw on the comprehensive approaches used to manage COVID-19 to help restore progress and mitigate the impact of COVID-19 on TB. Our team developed the ‘Swiss Cheese Model for Ending TB’ to illustrate that it is only through multisectoral collaborations that address the personal, societal and health system layers of care that we will end TB. In this paper, we examine how COVID-19 has impacted the different layers of TB care presented in the model and explore how we can leverage some of the lessons and outcomes of the COVID-19 pandemic to strengthen the global TB response.
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Affiliation(s)
- Alexandra Jaye Zimmer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,McGill International TB Centre, Montreal, Quebec, Canada
| | - Joel Shyam Klinton
- McGill International TB Centre, Montreal, Quebec, Canada.,TB PPM Learning Network, Montreal, Quebec, Canada
| | - Charity Oga-Omenka
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,McGill International TB Centre, Montreal, Quebec, Canada
| | - Petra Heitkamp
- McGill International TB Centre, Montreal, Quebec, Canada.,TB PPM Learning Network, Montreal, Quebec, Canada
| | | | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada .,McGill International TB Centre, Montreal, Quebec, Canada
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