Integrated Tuberculosis and COVID-19 Activities in Karachi and Tuberculosis Case Notifications

Abstract

As the COVID-19 pandemic surged, lockdowns led to the cancellation of essential health services. As part of our Zero TB activities in Karachi, we adapted our approach to integrate activities for TB and COVID-19 to decrease the impact on diagnosis and linkage to care for TB treatment. We implemented the following: (1) integrated COVID-19 screening and testing within existing TB program activities, along with the use of an artificial intelligence (AI) software reader on digital chest X-rays; (2) home delivery of medication; (3) use of telehealth and mental health counseling; (4) provision of PPE; (5) burnout monitoring of health workers; and (6) patient safety and disinfectant protocol. We used programmatic data for six districts of Karachi from January 2018 to March 2021 to explore the time trends in case notifications, the impact of the COVID-19 pandemic, and service adaptations in the city. The case notifications in all six districts in Karachi were over 80% of the trend-adjusted expected notifications with three districts having over 90% of the expected case notifications. Overall, Karachi reached 90% of the expected case notifications during the COVID-19 pandemic. The collaborative efforts by the provincial TB program and private sector partners facilitated this reduced loss in case notifications.

Tuberculosis Phenotypic and Genotypic Drug Susceptibility Testing and Immunodiagnostics: A Review

“…Cases of M.tb infection reactivation in people recovered from severe COVID-19 are reported ( 117 , 118 ). The struggle of using recourses for TB diagnosis and care to manage the current demand on COVID-19 is expected to have an impact on TB control ( 119 – 121 ). One of the key aspects to target TB elimination is early TB diagnosis that needs affordable and high-sensitivity POC tests able to diagnose pulmonary and extra pulmonary TB in adults, children, and PLWH ( 100 ).…”

The impact of the COVID-19 pandemic on patients’ experiences obtaining a tuberculosis diagnosis in Peru: a mixed-methods study

“…The difficulty of differentiating TB from COVID-19 symptoms and the instances of potentially incorrect COVID-19 diagnoses reported by participants in our study suggests the importance of integrated evaluation in places where both conditions are common. Models for integrated screening have been reported from multiple countries [26][27][28], and the Peruvian Ministry of Health has recently established an integrated evaluation algorithm for people with respiratory symptoms. Implementing integrated programs requires not only training providers in these algorithms, but also investment in robust testing capacity for both conditions.…”

MDR-TB in Pakistan: Challenges, efforts, and recommendations

“…To minimize the impact on diagnosis and treatment of TB during COVID 19, several approaches were taken in different cities like Karachi which include co-screening for COVID 19 and TB in pre-existing TB centers, home delivery of medicines, maintenance of protocols for the safety of both the patients and healthcare workers, closely monitoring the mental well-being of health care workers and calling in to check up on the patients who test positive [ 22 ]. ( Table 1 )…”