Challenges on tuberculosis care in health care facilities during COVID-19 pandemic: Indonesian perspective

Winardi, Wira; Wahyuni, Hendra; Hidayat, Moulid; Wirawan, Aditya; Uddin, Mohammad Nasir; Yusup, Mohamad

doi:10.52225/narra.v2i2.80

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…However, the current literature has primarily focused on TB health service disruptions. For example, in the case of both India [ 60 ] and Indonesia [ 61 ], studies have shown that a potential contributor to diminished diagnoses is that health centers temporarily stopped or reduced TB health services in order to focus more on COVID-19 services. For China, strict internal movement restrictions and reduced access to TB diagnostic equipment were cited as drivers for the drops in TB diagnoses among patients [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

Global-, Regional-, and National-Level Impacts of the COVID-19 Pandemic on Tuberculosis Diagnoses, 2020–2021

Ledesma,

Basting,

Chu

et al. 2023

Microorganisms

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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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Section: Discussionmentioning

confidence: 99%

Global-, Regional-, and National-Level Impacts of the COVID-19 Pandemic on Tuberculosis Diagnoses, 2020–2021

Ledesma,

Basting,

Chu

et al. 2023

Microorganisms

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“…6 Moreover, the pandemic led to the closure of healthcare facilities (HCFs), diversion of medical personnel toward COVID-19 prevention and treatment, reduced access to TB laboratory services and delays in follow-up visits for individuals with TB. [7][8][9][10] Additionally, several studies of public HCFs in Indonesia have shown that investigation of presumptive TB cases decreased during the pandemic, along with TB case notification rates and TB treatment coverage. 11 12 In contrast, a study of private HCFs reported no major changes in the quality of tuberculosis care due to the COVID-19 pandemic.…”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

“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

Mashuri,

Boettiger,

Wahyuningtias

et al. 2024

BMJ Glob Health

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IntroductionIn 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.MethodsWe 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.ResultsThere 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.ConclusionThe 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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“…Handling TB in Indonesia during the COVID-19 pandemic has become increasingly complex and challenging, as noted in recent reports (26). The fear of visiting health services for TB treatment, combined with the reduction of active or passive TB case-finding activities due to a shift in focus toward COVID-19 contract tracing, has led to a decline in reported TB cases (24,25).…”

Section: Challengesmentioning

confidence: 99%

Tuberculosis of the Urogenital and Central Nervous Systems Complicated With Septic Shock: Lessons Learned From a Resource-Limited Setting

Habiburrahman,

Rakasiwi

2023

JUMMEC

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The incidence of tuberculosis (TB) infection in multiple organs outside the lungs is of particular concern. We present the case of a 48-year-old woman with a history of pulmonary TB who had a gradual loss of consciousness in one day, worsening shortness of breath, and a cough with green phlegm two weeks before admission. She had been undergoing five days of TB treatment with the drug-sensitive TB treatment regimen. The genital examination revealed a whitish mass in the paraurethral area, which impaired her urination. Blood gas analysis showed respiratory acidosis, and a chest X-ray suggested pulmonary TB and concurrent community-acquired pneumonia. She was diagnosed with extrapulmonary tuberculosis (EPTB) in the central nervous systems and urogenital sites. To treat her lifethreatening EPTB, she received crystalloid infusions, oxygen supplementation, ampicillin-sulbactam (converted to meropenem the next day), an oral fixed-dose combination antituberculosis therapy, pyridoxine, N-acetylcysteine, ursodeoxycholic acid, Curcuma, bisoprolol, proton pump inhibitor, and antiemetics. Additionally, she was inserted with a urethral catheter and a nasogastric tube to assist her urination and nutritional intake. Our facility was a subdistrict hospital and had a limited capacity for diagnosing and treating EPTB due to a lack of advanced intensive care units, blood and sputum cultures, and laboratory panels. After her two-day hospital admission to ICU for stabilisation, she was referred to a higher-level hospital with more advanced pulmonary treatment overseen by a multidisciplinary team. Our resource limitations highlight the importance of being

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Challenges on tuberculosis care in health care facilities during COVID-19 pandemic: Indonesian perspective

Cited by 6 publications

References 14 publications

Global-, Regional-, and National-Level Impacts of the COVID-19 Pandemic on Tuberculosis Diagnoses, 2020–2021

Global-, Regional-, and National-Level Impacts of the COVID-19 Pandemic on Tuberculosis Diagnoses, 2020–2021

“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

Tuberculosis of the Urogenital and Central Nervous Systems Complicated With Septic Shock: Lessons Learned From a Resource-Limited Setting

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