Background Essential health services, including for tuberculosis (TB), are being affected by public health and social measures (PHSM) introduced to control COVID-19. In many settings, TB resources, facilities and equipment are being redirected towards COVID-19 response. Aim We sought to assess the COVID-19 pandemic’s impact on TB services in the World Health Organization (WHO) European Region. Methods The fifty-three European Region Member States were asked to report qualitative and quantitative data in quarter one and two (Q1 and Q2) 2020. TB notifications were triangulated with the severity score on domestic movement restrictions to assess how they may have influenced TB detection. Results Twenty-nine countries reported monthly TB notifications for the first half of 2019 and 2020. TB notifications decreased by 35.5% during Q2 2020 compared with Q2 2019, which is six-fold more than the average annual decrease of 5.1% documented during 2015–2019. The number of patients enrolled in rifampicin-resistant/multidrug-resistant TB treatment also decreased dramatically in Q2 2020, by 33.5%. The highest movement restriction severity score was observed between April and May 2020, which coincided with the highest observed decrease in TB notifications. Conclusion A decrease in TB detection and enrolment to treatment may cause increases in TB burden and threatens the Region’s ability to reach the TB targets of the 2030 Sustainable Development Goals, still this might be mitigated with rapid restoration of TB services and the implementation of targeted interventions during periods with severe PHSM in place, such as those introduced in response to the COVID-19 pandemic.
In Ukraine, about one-third of identified HIV-positive individuals are not connected to care. We conducted a cross-sectional survey (n = 200) among patients registered at Odessa AIDS centers in October to December 2011. Factors associated with delayed enrollment in HIV care (>3 months since positive HIV test) were evaluated using logistic regression. Among study participants (mean age 35 ± 8.2 years, 47.5% female, 42.5% reported history of injecting drugs), 55% delayed HIV care enrollment. Odds of delayed enrollment were higher for those with lower educational attainment (adjusted odds ratio [aOR]: 2.65, 95% confidence interval [CI]: 1.04-6.76), not feeling ill (aOR: 2.98, 95% CI: 1.50-5.93), or not having time to go to the AIDS center (aOR: 3.89, 95% CI: 1.39-10.89); injection drug use was not associated with delayed enrollment. Programs linking HIV-positive individuals to specialized care should address enrollment barriers and include education on HIV care benefits and case management for direct linkage to care. HIV testing and treatment should be coupled to ensure a continuum of care.
Mass gatherings (MG) present a number of challenges to public health authorities and governments across the world with sporting events, tournaments, music festivals, religious gatherings and all other MG having historically posed a risk to the spread and amplification of a range of infectious diseases. Transmission of gastrointestinal, respiratory, waterborne and sexually transmitted infectious diseases pose a particular risk: all have been linked to MG events [1–4]. Infection risk often depends on the nature of the mass gathering, and on the profile and behaviour of its participants. The interaction between environmental, psychological, biological and social factors plays a vital part. The risk of outbreaks particularly as a result of respiratory transmission remains high at MG, with the majority of outbreaks over the last two decades resulting from a variety of respiratory and vaccine preventable pathogens [5–7]. Concerns about the spread of infectious diseases at MG are often focussed on crowding, lack of sanitation and the mixing of population groups from different places. Sporting events, which have in recent decades become more complex and international in nature, pose a challenge to the control of communicable disease transmission [8]. Despite this, large scale outbreaks at sporting events have been rare in recent decades, particularly since the rise of more robust public health planning, prevention, risk assessment and improved health infrastructures in host countries [9].
Public health and social measures (PHSM) have been utilized as a tool to reduce the infection rates and disease burden throughout the COVID-19 pandemic and continue to play an important role even with vaccination campaigns well underway in preventing severe disease. In order to systematically track, analyze and report qualitative and quantitative data o PHSM implementation across the European Region and assist countries in the COVID-19 response, the COVID-19 Incident Management Support team at the WHO Regional Office for Europe developed PHSM Severity Index and PHSM Dashboard. The PHSM Severity Index captures the types, severity and timing of PHSMs implemented by a country across six main indicators. By providing standardized data on PHSM implementation, the PHSM Severity Index can support and inform the development of policy at country and regional levels. PHSM data, severity methodology and policy tools developed throughout the COVID-19 pandemic should be adapted to provide a foundation for preparedness for future large-scale health emergencies. In addition, discerning the epidemiological impact of specific PHSM and their combinations currently is a priority for policy-makers and can guide countries’ transition strategies. Analysing the impact of PHSM on COVID-19 transmission is of critical importance, especially as variants of concern bring new waves of COVID-19 cases and may challenge countries’ vaccination and response strategies. Reference PHSM in Response to COVID-19 (who.int)
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