Tuberculosis (TB) in Korea remains a serious health problem with an estimated 77 per 100,000 incidence rate for 2016. This makes Korea as the only OECD country with high incidence of TB. The government has increased budgets and strengthened patient management policies since 2011. The management of latent tuberculosis was added to the response with strengthened and extensive contact investigations in the five-year tuberculosis control plan (2013–2017) and implementation was established in 2013. Due to these efforts Korea has achieved an average 5.2% reduction annually in tuberculosis incidence rate between 2011 and 2016. To further expedite the reduction of the TB burden the government has introduced additional measures including mandatory screening of latent tuberculosis infection for community workers in congregate settings including daycare centers for children, kindergarten, and teachers in schools and health care workers in clinics and hospitals to solve the problems identified through contact investigations in 2017.Providing high quality free diagnosis and treatment of active TB including for multidrug resistant TB combined with active contact investigations is the mainstay of the current programmatic response in Korea. However, the limitation of existing tools for LTBI pose challenge including absence of best mechanism for effective communication with professionals and the public, the need for at least 3 months of treatment and the risk of side effects. Developing effective tools will help to overcome these challenges.
Background
The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to healthcare systems and endangered the control and prevention of tuberculosis (TB). We investigated the nationwide effects of COVID-19 on the national Public-Private Mix (PPM) TB control project in Korea, using monitoring indicators from the Korean PPM monitoring database.
Methods
The Korean PPM monitoring database includes data from patients registered at PPM hospitals throughout the country. Data of six monitoring indicators for active TB cases updated between July 2019 and June 2020 were collected. The data of each cohort throughout the country and in Daegu-Gyeongbuk, Seoul Metropolitan Area, and Jeonnam-Jeonbuk were collated to provide nationwide data. The data were compared using the χ
2
test for trend to evaluate quarterly trends of each monitoring indicator at the national level and in the prespecified regions.
Results
Test coverages of sputum smear (
P
= 0.622) and culture (
P
= 0.815), drug susceptibility test (
P
= 0.750), and adherence rate to initial standard treatment (
P
= 0.901) at the national level were not significantly different during the study period. The rate of loss to follow-up among TB cases at the national level was not significantly different (
P
= 0.088); however, the treatment success rate among the smear-positive drug-susceptible pulmonary TB cohort at the national level significantly decreased, from 90.6% to 84.1% (
P
< 0.001). Treatment success rate in the Seoul metropolitan area also significantly decreased during the study period, from 89.4% to 84.5% (
P
= 0.006).
Conclusion
Our study showed that initial TB management during the COVID-19 pandemic was properly administered under the PPM project in Korea. However, our study cannot confirm or conclude a decreased treatment success rate after the COVID-19 pandemic due to limited data.
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