The impact of the COVID-19 pandemic and associated suppression measures on the burden of tuberculosis in India

Abstract

Background Tuberculosis (TB) is a major cause of death globally. India carries the highest share of the global TB burden. The COVID-19 pandemic has severely impacted diagnosis of TB in India, yet there is limited data on how TB case reporting has changed since the pandemic began and which factors determine differences in case notification. Methods We utilized publicly available data on TB case reporting through the Indian Central TB Division from January 2017 through April of 2021 (prior to the first COVID-19 related lockdown). Using a Poisson model, we estimated seasonal and yearly patterns in TB case notification in India from January 2017 through February 2020 and extended this estimate as the counterfactual expected TB cases notified from March 2020 through April 2021. We characterized the differences in case notification observed and those expected in the absence of the pandemic by State and Territory. We then performed a linear regression to examine the relationship between the logit ratio of reported TB to counterfactual cases and mask use, mobility, daily hospitalizations/100,000 population, and public/total TB case reporting. Results We found 1,320,203 expected cases of TB (95% uncertainty interval (UI) 1,309,612 to 1,330,693) were not reported during the period from March 2020 through April 2021. This represents a 63.3% difference (95% UI 62.8 to 63.8) in reporting. We found that mobility data and average hospital admissions per month per population were correlated with differences in TB case notification, compared to the counterfactual in the absence of the pandemic (p > 0.001). Conclusion There was a large difference between reported TB cases in India and those expected in the absence of the pandemic. This information can help inform the Indian TB program as they consider interventions to accelerate case finding and notification once the pandemic related TB service disruptions improve. Mobility data and hospital admissions are surrogate measures that correlate with a greater difference in reported/expected TB cases and may correlate with a disruption in TB diagnostic services. However, further research is needed to clarify this association and identify other key contributors to gaps in TB case notifications in India.

Study of tuberculosis in post COVID19 patients at tertiary center

“…These variables may be surrogate measures for disruption in TB diagnostic services or, alternatively, the impact of mask use and decreased mobility on transmission dynamics. 20 National TB Elimination Programme (NTEP) announced a Rapid Response Plan, which includes bi-directional TB-Covid-19 screening, intensified case finding, replacement of sputum smears with rapid molecular testing, home-based sample collection and delivery of TB medicines, and modification of the DOTS approach to include digital adherence technologies, call centers and family members to provide treatment support. 21 Still certain conditions are yet to scientifically clear, such as 22 1.…”

Impact of the COVID-19 pandemic on tuberculosis notification in Brazil

“…The impact on national-level TB notifications in 2020 (14.4%) was similar to that reported in Mozambique (15.1%) 3 , but lower than in India, that had a relative loss of cases of 63.3% during the period from March 2020 through April 2021. 16 Other studies estimated the effect of the pandemic on TB case notifications with different approaches and also have found an immediate impact. Reported data from facilities in 2020 revealed a decline in TB case notifications of 34% 17 in Nigeria and of 43% in Uganda.…”

Tuberculosis in Brazil: the impact of the COVID-19 pandemic

“…(1,2,3,4,5,6,7) A eliminação da COVID-19 tem sido priorizada em relação a outras doenças que podem ser tratadas pela saúde pública. (7,8) Durante a pandemia da COVID-19, observou-se um grande impacto na prestação de serviços de saúde da TB em vários países, por meio de medidas de remanejamento de profissionais e orçamentos, e a interrupção de serviços. (3,4,5,6,7,8) .…”

“…(7,8) Durante a pandemia da COVID-19, observou-se um grande impacto na prestação de serviços de saúde da TB em vários países, por meio de medidas de remanejamento de profissionais e orçamentos, e a interrupção de serviços. (3,4,5,6,7,8) . No entanto, não sabemos a verdadeira extensão desse dano; espera-se um aumento no número de casos de TB não diagnosticados em todo o mundo, o que pode evidenciar maus resultados do tratamento.…”

“…No entanto, não sabemos a verdadeira extensão desse dano; espera-se um aumento no número de casos de TB não diagnosticados em todo o mundo, o que pode evidenciar maus resultados do tratamento. (3,4,5,6,7,8) A apresentação simultânea de TB e COVID-19 é motivo de preocupação, pois o paciente pode estar em maior risco de desfechos ruins e morte do que pacientes com somente COVID-19. (7,8) No Brasil, a TB é um problema de saúde pública e de notificação compulsória, e a situação atual apresenta um alto ônus de co-infecção com TB e TB-HIV.…”