Impact of COVID-19 on the National Tuberculosis Elimination Program in Uttarakhand, India: A Mixed-Methods Research Study

Garg, Kirti; Bahurupi, Yogesh; Aggarwal, Pradeep; Badola, Mayank

doi:10.1016/j.infpip.2023.100269

Cited by 3 publications

(2 citation statements)

References 16 publications

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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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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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“…The COVID-19 pandemic response has shown systemic failures in our preparedness and response [ 3 , 4 ]. COVID-19 impacted many effective health programs, including the TB program [ 5 , 6 ]. TB detection and eradication benefits have decreased due to the COVID-19 pandemic's compromise of TB diagnosis, treatment, and prevention [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Impact on Tuberculosis Notification During COVID-19 Pandemic in India: A Narrative Review

Sahu,

Nagtode

2023

Cureus

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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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The impact of the COVID-19 pandemic on tuberculosis treatment outcomes in 49 high burden countries

Gunsaru,

Henrion,

McQuaid

2024

BMC Med

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Background The COVID-19 pandemic disrupted tuberculosis (TB) health services, including treatment support and access to drugs, as patients were not able to access health facilities. While the effect of this disruption on treatment outcomes has been studied in isolated treatment centres, cities and provinces, the impact of the pandemic on TB treatment outcomes at a country and regional level has not been evaluated. Methods We used treatment outcomes for new and relapse TB cases reported to the World Health Organization (WHO) from 49 high TB, TB/HIV and drug-resistant TB burden countries from 2012 to 2019. We developed multinomial logistic regression models for trends in TB treatment success, failure, death and loss to follow up. We predicted TB treatment outcomes for 2020 and 2021, comparing these to observations, by computing ratios between observed and predicted probabilities. We aggregated these risk ratios (RR) for six WHO-defined regions using random-effects meta-analysis. Results Across 49 countries and four TB treatment outcomes, 17 (out of 196) country-outcome pairs in 2020 and 21 in 2021 had evidence of systematic differences between observed and predicted TB treatment outcome probabilities. Regionally, only four (out of 24) region-outcome pairs had evidence of systematic differences in 2020 and four in 2021, where the European region accounted for four of these in total. Globally, there was evidence of systematic differences in treatment failure in both 2020 (RR: 1.14, 95%CI: 1.01–1.28, p = 0.0381) and 2021 (RR: 1.36, 95%CI: 1.03–1.78, p = 0.0277), deaths in 2020 (RR: 1.08, 95%CI: 1.03–1.13, p = 0.0010) and losses to follow up in 2020 (RR: 0.91, 95%CI: 0.86–0.97, p = 0.0059). Conclusions While for some countries and regions there were significant differences between observed and predicted treatment outcomes probabilities, there was insufficient evidence globally to identify systematic differences between observed and expected TB treatment outcome probabilities because of COVID-19-associated disruptions in general. However, larger numbers of treatment failures and deaths on treatment than expected were observed globally, suggesting a need for further investigation.

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Impact of COVID-19 on the National Tuberculosis Elimination Program in Uttarakhand, India: A Mixed-Methods Research Study

Cited by 3 publications

References 16 publications

“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

“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

Impact on Tuberculosis Notification During COVID-19 Pandemic in India: A Narrative Review

The impact of the COVID-19 pandemic on tuberculosis treatment outcomes in 49 high burden countries

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