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1.
Lancet Respir Med ; 10(6): 603-622, 2022 06.
Article in English | MEDLINE | ID: covidwho-1758001

ABSTRACT

The global tuberculosis burden remains substantial, with more than 10 million people newly ill per year. Nevertheless, tuberculosis incidence has slowly declined over the past decade, and mortality has decreased by almost a third in tandem. This positive trend was abruptly reversed by the COVID-19 pandemic, which in many parts of the world has resulted in a substantial reduction in tuberculosis testing and case notifications, with an associated increase in mortality, taking global tuberculosis control back by roughly 10 years. Here, we consider points of intersection between the tuberculosis and COVID-19 pandemics, identifying wide-ranging approaches that could be taken to reverse the devastating effects of COVID-19 on tuberculosis control. We review the impact of COVID-19 at the population level on tuberculosis case detection, morbidity and mortality, and the patient-level impact, including susceptibility to disease, clinical presentation, diagnosis, management, and prognosis. We propose strategies to reverse or mitigate the deleterious effects of COVID-19 and restore tuberculosis services. Finally, we highlight research priorities and major challenges and controversies that need to be addressed to restore and advance the global response to tuberculosis.


Subject(s)
COVID-19 , Tuberculosis , COVID-19/epidemiology , Humans , Incidence , Pandemics , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Tuberculosis/therapy
2.
Lancet Glob Health ; 10(3): e390-e397, 2022 03.
Article in English | MEDLINE | ID: covidwho-1747373

ABSTRACT

BACKGROUND: Universal health coverage is one of the WHO End TB Strategy priority interventions and could be achieved-particularly in low-income and middle-income countries-through the expansion of primary health care. We evaluated the effects of one of the largest primary health-care programmes in the world, the Brazilian Family Health Strategy (FHS), on tuberculosis morbidity and mortality using a nationwide cohort of 7·3 million individuals over a 10-year study period. METHODS: We analysed individuals who entered the 100 Million Brazilians Cohort during the period Jan 1, 2004, to Dec 31, 2013, and compared residents in municipalities with no FHS coverage with residents in municipalities with full FHS coverage. We used a cohort design with multivariable Poisson regressions, adjusted for all relevant demographic and socioeconomic variables and weighted with inverse probability of treatment weighting, to estimate the effect of FHS on tuberculosis incidence, mortality, cure, and case fatality. We also performed a range of stratifications and sensitivity analyses. FINDINGS: FHS exposure was associated with lower tuberculosis incidence (rate ratio [RR] 0·78, 95% CI 0·72-0·84) and mortality (0·72, 0·55-0·94), and was positively associated with tuberculosis cure rates (1·04, 1·00-1·08). FHS was also associated with a decrease in tuberculosis case-fatality rates, although this was not statistically significant (RR 0·84, 95% CI 0·55-1·30). FHS associations were stronger among the poorest individuals for all the tuberculosis indicators. INTERPRETATION: Community-based primary health care could strongly reduce tuberculosis morbidity and mortality and decrease the unequal distribution of the tuberculosis burden in the most vulnerable populations. During the current marked rise in global poverty due to the COVID-19 pandemic, investments in primary health care could help protect against the expected increases in tuberculosis incidence worldwide and contribute to the attainment of the End TB Strategy goals. FUNDING: TB Modelling and Analysis Consortium (Bill & Melinda Gates Foundation), Wellcome Trust, and Brazilian Ministry of Health. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.


Subject(s)
Community Health Services/statistics & numerical data , Primary Health Care/statistics & numerical data , Tuberculosis/epidemiology , Tuberculosis/therapy , Universal Health Insurance/statistics & numerical data , Adolescent , Adult , Age Distribution , Brazil/epidemiology , Cohort Studies , Community Health Services/methods , Female , Humans , Incidence , Longitudinal Studies , Male , Poverty/statistics & numerical data , Primary Health Care/methods , Young Adult
3.
Front Immunol ; 13: 833715, 2022.
Article in English | MEDLINE | ID: covidwho-1731782

ABSTRACT

2020 will be marked in history for the dreadful implications of the COVID-19 pandemic that shook the world globally. The pandemic has reshaped the normality of life and affected mankind in the aspects of mental and physical health, financial, economy, growth, and development. The focus shift to COVID-19 has indirectly impacted an existing air-borne disease, Tuberculosis. In addition to the decrease in TB diagnosis, the emergence of the TB/COVID-19 syndemic and its serious implications (possible reactivation of latent TB post-COVID-19, aggravation of an existing active TB condition, or escalation of the severity of a COVID-19 during TB-COVID-19 coinfection), serve as primary reasons to equally prioritize TB. On a different note, the valuable lessons learnt for the COVID-19 pandemic provide useful knowledge for enhancing TB diagnostics and therapeutics. In this review, the crucial need to focus on TB amid the COVID-19 pandemic has been discussed. Besides, a general comparison between COVID-19 and TB in the aspects of pathogenesis, diagnostics, symptoms, and treatment options with importance given to antibody therapy were presented. Lastly, the lessons learnt from the COVID-19 pandemic and how it is applicable to enhance the antibody-based immunotherapy for TB have been presented.


Subject(s)
Antibodies/therapeutic use , COVID-19/epidemiology , COVID-19/therapy , Coinfection/therapy , Tuberculosis/epidemiology , Tuberculosis/therapy , Antibodies/immunology , COVID-19/diagnosis , COVID-19/immunology , Coinfection/diagnosis , Coinfection/epidemiology , Coinfection/immunology , Humans , Immunotherapy , Mycobacterium tuberculosis , Receptors, Antigen, T-Cell/immunology , SARS-CoV-2/immunology , Tuberculosis/diagnosis , Tuberculosis/immunology
4.
BMJ Open ; 12(2): e057291, 2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1723820

ABSTRACT

INTRODUCTION: Although the advanced HIV disease (AHD) care package reduces morbidity and mortality in people with AHD (defined in people living with HIV as WHO stage 3 or 4, CD4 count <200 cells/µL or age <5 years), it is barely implemented in many countries. A novel point-of-care CD4 test rapidly identifies AHD. We evaluate the feasibility of implementing the AHD care package as part of community-based HIV/tuberculosis services. METHODS AND ANALYSIS: This two-phased study is guided by the Medical Research Council framework for evaluation of complex interventions. Stage 1 is a stakeholder consultation to define tools and indicators to assess feasibility of the AHD care package. Stage 2 is the implementation of the AHD care package during a facility-based tuberculosis diagnostic accuracy study in high-burden HIV/tuberculosis settings. Consenting adults with tuberculosis symptoms in two sites in Lesotho and South Africa are eligible for inclusion. HIV-positive participants are included in the feasibility study and are offered a CD4 test, a tuberculosis-lipoarabinomannan assay and those with CD4 count of ≤200 cells/µL a cryptococcal antigen lateral flow assay. Participants are referred for clinical management following national guidelines. The evaluation includes group discussions, participant observation (qualitative strand) and a semistructured questionnaire to assess acceptability among implementers. The quantitative strand also evaluates process compliance (process rating and process cascade) and early outcomes (vital and treatment status after twelve weeks). Thematic content analysis, descriptive statistics and data triangulation will be performed. ETHICS AND DISSEMINATION: The National Health Research and Ethics Committee, Lesotho, the Human Sciences Research Council Research Ethics Committee and Provincial Department of Health, South Africa and the Ethikkommission Nordwest- und Zentralschweiz, Switzerland, approved the protocol. Dissemination will happen locally and internationally at scientific conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04666311.


Subject(s)
HIV Infections , Tuberculosis , Adult , CD4 Lymphocyte Count , Child, Preschool , Feasibility Studies , HIV Infections/drug therapy , Humans , Point-of-Care Systems , Tuberculosis/drug therapy , Tuberculosis/therapy
7.
Ann Glob Health ; 87(1): 109, 2021.
Article in English | MEDLINE | ID: covidwho-1538730

ABSTRACT

Background: There were global concerns and predictions that Coronavirus disease 2019 (COVID-19) would severely affect tuberculosis (TB) care and treatment services in resource-constrained countries. This study aimed to assess the real-time impact of COVID-19 on clinical care and treatment of patients with TB in Addis Ababa, Ethiopia. Methods: This was a facility-based, multicenter, cross-sectional study conducted in 10 health centers with high TB clients in Addis Ababa, Ethiopia. Participants were patients with TB who have been attending TB clinical care and treatment in the COVID-19 pandemic period. Data were collected using adapted, interviewer-administered questionnaires to investigate the impact of COVID-19 in their routine care and treatment. Result: The study included a total of 212 consented participants. Study participants who missed appointments for medication refill were 40 (18.9%). The most important predictors of missed appointments were fear of COVID-19 [AOR = 4.25, 95% CI (1.710-25.446)], transport disruption [AOR = 8.88, 95% CI (1.618-48.761)], lockdown [AOR = 6.56, 95% CI (1.300-33.131)], traveling costs [AOR = 10.26, 95% CI (1.552-67.882)], and personal protective equipment costs [AOR = 11.15, 95% CI (2.164-57.437)]. The most costly COVID-19 preventive measures that caused financial burden to the patients were face mask [107 (50.5%)], disinfectant [106 (50%)], and sop [50 (23.6%)]. The participants were well aware of the recommended COVID-19 preventive measures. Their perceived most effective preventive measures were the use of face mask (90.1%), frequent hand washing with soap and use of disinfectant (83.0%), avoid touching eyes, nose and mouth with unwashed hands (77.8%), and stay at home (75.5%). Conclusions: COVID-19 significantly hampered the clinical care and treatment of patients with TB. The impact was primarily on their appointments for scheduled medication refills, clinical follow-ups, and laboratory follow-ups. Fear of getting infected with COVID-19, limited access to transportation, reduced income for traveling to health facilities, costs for personal protective equipment and traveling to healthcare facilities, and the lockdown were the major determinants. The impact could be mitigated by reducing the number of visits, rationing personal protective equipment as feasible, compensating travel expenses, providing health educations and community-based TB services, and maintaining TB services.


Subject(s)
COVID-19 , Tuberculosis , Communicable Disease Control , Cross-Sectional Studies , Ethiopia/epidemiology , Humans , Pandemics , SARS-CoV-2 , Tuberculosis/epidemiology , Tuberculosis/therapy
8.
PLoS One ; 16(11): e0260389, 2021.
Article in English | MEDLINE | ID: covidwho-1533422

ABSTRACT

BACKGROUND: In recent non-pandemic periods, tuberculosis (TB) has been the leading killer worldwide from a single infectious disease. Patients with DM are three times more likely to develop active TB and poor treatment outcomes. Single glycemic measurements at TB diagnosis may inaccurately diagnose or mischaracterize DM severity. Data are limited regarding glycemic dynamics from TB diagnosis through treatment. METHODS: Prospective study of glycemia dynamics in response to TB treatment measured glycosylated haemoglobin (HbA1c) in patients presenting to TB screening centres in Bangladesh to determine the prevalence and risk factors of hyperglycemia before and at TB treatment completion. RESULTS: 429 adults with active TB disease were enrolled and divided into groups based on history of DM and initial HbA1c range: normoglycemia, prediabetes, and DM. DM was diagnosed in 37%. At treatment completion,14(6%) patients from the normoglycemia and prediabetes groups had HbA1c>6.5%, thus increasing the prevalence of DM to 39%. The number needed to screen to diagnose one new case of DM at TB diagnosis was 5.7 and 16 at treatment completion in the groups without DM. Weight gain>5% at treatment completion significantly increased the risk of hyperglycemia in the groups without DM at TB diagnosis (95% CI 1.23-26.04, p<0.05). CONCLUSION: HbA1c testing prior to and at TB treatment completion found a high prevalence of prediabetes and DM, including a proportion found at treatment completion and commonly in people with a higher percentage of weight gain. Further longitudinal research is needed to understand the effects of TB disease and treatment on insulin resistance and DM complications.


Subject(s)
Diabetes Mellitus/diagnosis , Hyperglycemia/diagnosis , Prediabetic State/diagnosis , Tuberculosis/complications , Adolescent , Adult , Bangladesh/epidemiology , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Disease Management , Female , Glycated Hemoglobin A/analysis , Humans , Hyperglycemia/blood , Hyperglycemia/epidemiology , Male , Middle Aged , Prediabetic State/blood , Prediabetic State/epidemiology , Prospective Studies , Risk Factors , Tuberculosis/diagnosis , Tuberculosis/therapy , Young Adult
9.
Lancet Respir Med ; 9(12): e118-e119, 2021 12.
Article in English | MEDLINE | ID: covidwho-1504197
10.
J Epidemiol Community Health ; 76(3): 310-316, 2022 03.
Article in English | MEDLINE | ID: covidwho-1430205

ABSTRACT

The COVID-19 pandemic has caused widespread disruptions to tuberculosis (TB) care and service delivery in 2020, setting back progress in the fight against TB by several years. As newer COVID-19 variants continue to devastate many low and middle-income countries in 2021, the extent of this setback is likely to increase. Despite these challenges, the TB community can draw on the comprehensive approaches used to manage COVID-19 to help restore progress and mitigate the impact of COVID-19 on TB. Our team developed the 'Swiss Cheese Model for Ending TB' to illustrate that it is only through multisectoral collaborations that address the personal, societal and health system layers of care that we will end TB. In this paper, we examine how COVID-19 has impacted the different layers of TB care presented in the model and explore how we can leverage some of the lessons and outcomes of the COVID-19 pandemic to strengthen the global TB response.


Subject(s)
COVID-19 , Tuberculosis , Humans , Pandemics , Tuberculosis/epidemiology , Tuberculosis/therapy
14.
Natl Med J India ; 33(5): 298-301, 2020.
Article in English | MEDLINE | ID: covidwho-1289146

ABSTRACT

India has the largest global burden of new cases of tuberculosis (TB) and deaths due to TB. These occur predominantly in the poor who suffer catastrophic costs during diagnosis and treatment. The National Tuberculosis Elimination Programme has ambitious goals of 80% reduction of incidence of TB, 90% reduction in mortality due to TB by 2025 and 0% occurrence of catastrophic costs to households affected by TB by 2020. The Covid-19 pandemic and the resulting disruption to TB services are expected to worsen the situation. There are gaps in case finding at the peripheral level and access to care at the higher level for patients with TB. An estimated 32% patients with active TB do not access diagnostic services, while catastrophic costs associated with hospitalization are a barrier to access for seriously ill patients. Deaths due to TB in India occur largely at home and not in medical facilities, and are preventable with appropriate inpatient care. The Ayushman Bharat scheme with its Health and Wellness Centres (HWCs) and coverage for inpatient care under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) can facilitate, the achievement of the goals of TB elimination. The HWCs provide an opportunity to close the case-finding gap as first point of contact by enabling sputum transport services to the designated microscopy centres. This will facilitate case detection, reduce diagnostic delays, and decrease community transmission and the incidence of TB. The benefit package of PM-JAY can cover patients with pulmonary TB, inpatient evaluation for other forms of TB, enhance the allocation for treatment and cover management of comorbid conditions such as severe undernutrition, anaemia, HIV and diabetes.


Subject(s)
COVID-19 , Communicable Disease Control/organization & administration , Early Diagnosis , Hospitalization , Patient Care Management , Tuberculosis , Universal Health Insurance , COVID-19/epidemiology , COVID-19/prevention & control , Health Expenditures , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Health Services Needs and Demand , Humans , India/epidemiology , Mortality , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/trends , Public Health/methods , Public Health/trends , Quality Improvement/organization & administration , SARS-CoV-2 , Time-to-Treatment , Tuberculosis/diagnosis , Tuberculosis/economics , Tuberculosis/mortality , Tuberculosis/therapy
15.
Health Care Women Int ; 41(11-12): 1226-1239, 2020.
Article in English | MEDLINE | ID: covidwho-1263593

ABSTRACT

The COVID-19 pandemic and its health, economic and social aftermath has currently overshadowed every other health concern throughout the world. There are numerous ways in which this will impact existing public health issues. In this article we aim to examine and reflect on the interactions between COVID-19 and tuberculosis (TB) another scourge which has long been the world's leading infectious killer. There are potentially grave consequences for existing and undiagnosed TB patients globally, particularly in low and middle income countries like India where TB is endemic and health services poorly equipped. TB control programmes are likely to be strained due to diversion of resources, and an inevitable loss of health system focus. This is likely to lead to a reduction in quality of TB care and worse outcomes. The symptoms of TB and COVID-19 can be similar, for instance symptoms like cough and fever. Not only can this create diagnostic confusion, but it could worsen the stigmatization of TB patients especially in LMICs, given the fear of COVID-19. Women with TB in India are a vulnerable group as gender disparities play a significant role in how men and women access healthcare in the public and private sectors. They are especially likely to suffer as part of the "collateral damage" and also experience the impact of the double stigma disproportionately. In this paper the researchers examine the impact of Covid 19 on women seeking TB care in India.


Subject(s)
COVID-19/complications , Tuberculosis/epidemiology , Delivery of Health Care , Female , Government Programs , Healthcare Disparities , Humans , India/epidemiology , Male , SARS-CoV-2 , Tuberculosis/therapy
18.
J Int AIDS Soc ; 24(4): e25696, 2021 04.
Article in English | MEDLINE | ID: covidwho-1160594

ABSTRACT

INTRODUCTION: Until COVID-19, tuberculosis (TB) was the leading infectious disease killer globally, disproportionally affecting people with HIV. The COVID-19 pandemic is threatening the gains made in the fight against both diseases. DISCUSSION: Although crucial guidance has been released on how to maintain TB and HIV services during the pandemic, it is acknowledged that what was considered normal service pre-pandemic needs to improve to ensure that we rebuild person-centred, inclusive and quality healthcare services. The threat that the pandemic may reverse gains in the response to TB and HIV may be turned into an opportunity by pivoting to using proven differentiated service delivery approaches and innovative technologies that can be used to maintain care during the pandemic and accelerate improved service delivery in the long term. Models of care should be convenient, supportive and sufficiently differentiated to avoid burdensome clinic visits for medication pick-ups or directly observed treatments. Additionally, the pandemic has highlighted the chronic and short-sighted lack of investment in health systems and the need to prioritize research and development to close the gaps in TB diagnosis, treatment and prevention, especially for children and people with HIV. Most importantly, TB-affected communities and civil society must be supported to lead the planning, implementation and monitoring of TB and HIV services, especially in the time of COVID-19 where services have been disrupted, and to report on legal, policy and gender-related barriers to access experienced by affected people. This will help to ensure that TB services are held accountable by affected communities for delivering equitable access to quality, affordable and non-discriminatory services during and beyond the pandemic. CONCLUSIONS: Successfully reaching the related targets of ending TB and AIDS as public health threats by 2030 requires rebuilding of stronger, more inclusive health systems by advancing equitable access to quality TB services, including for people with HIV, both during and after the COVID-19 pandemic. Moreover, services must be rights-based, community-led and community-based, to ensure that no one is left behind.


Subject(s)
COVID-19/epidemiology , HIV Infections/therapy , Quality of Health Care , SARS-CoV-2 , Tuberculosis/therapy , Community Health Services , Humans
20.
Indian J Tuberc ; 67(4S): S155-S162, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1125790

ABSTRACT

The SARS-2 pandemic which has moved with frightening speed over the last 5 months has several synergies with another older, and far more neglected airborne disease, tuberculosis. Patients with tuberculosis are not only more likely to be infected by SARS-CoV-2 but also likely to have adverse outcomes once infected. The sequelae of more severe forms of COVID-19 in patients who have recovered from TB but have residual compromised lung function, are also likely to be devastating. These diseases share almost identical bio-social determinants like poverty, overcrowding, diabetes and pollution and some clinical similarities. The consequences of the COVID-19 pandemic, and our global response to it with lockdowns, are likely to leave a profound and long-lasting impact on TB diagnosis and control, potentially leading to an additional 6.3 million cases of TB between 2020 and 2025, and an additional 1.4 million TB deaths during this time. Novel solutions will need to be urgently devised or else TB control targets will never be met and indeed may be set back by 5-8 years.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Coinfection/epidemiology , SARS-CoV-2 , Tuberculosis/complications , Tuberculosis/epidemiology , COVID-19/therapy , Humans , Risk Factors , Socioeconomic Factors , Tuberculosis/therapy
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