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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 478-479

The impact of the COVID-19 pandemic on tuberculosis services


1 Bart's and the London School of Medicine and Dentistry, London, UK
2 Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia; Department of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Perú; School of Medicine, Universidad Privada Franz Tamayo (UNIFRANZ), Cochabamba, Bolivia
3 Professor of Epidemiology & Public Health Director of ISPM, Switzerland

Date of Submission01-Oct-2021
Date of Decision15-Oct-2021
Date of Acceptance05-Nov-2021
Date of Web Publication14-Dec-2021

Correspondence Address:
Pablo Alfonso Palanca
Flat 75 Seacon Tower, 5 Hutchings Street, E14 8JX, London
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_223_21

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How to cite this article:
Palanca PA, Rodriguez-Morales AJ, Franco OH. The impact of the COVID-19 pandemic on tuberculosis services. Int J Mycobacteriol 2021;10:478-9

How to cite this URL:
Palanca PA, Rodriguez-Morales AJ, Franco OH. The impact of the COVID-19 pandemic on tuberculosis services. Int J Mycobacteriol [serial online] 2021 [cited 2022 Jan 21];10:478-9. Available from: https://www.ijmyco.org/text.asp?2021/10/4/478/332366



Dear Editor,

Severe lack of funding and resources meant that struggling tuberculosis (TB) services were weak and ill-equipped to deal with the simultaneous coronavirus disease 2019 (COVID-19) and TB pandemics (syndemic).[1] Furthermore, unsafe and challenging working conditions, exacerbated by the reallocation of staff, diagnostic platforms, and beds to tackle the COVID-19 pandemic, saw significant reductions in the number of health facilities offering TB diagnostic and treatment services.[1] Consequently, case detection and treatment enrolment in 2020 fell by 23% (compared with 2019) among the nine countries accounting for 60% of the global TB burden,[2] thus eliminating 12 years of progress in the global fight against TB.

This sharp fall in case detection and treatment may potentially have medium to long-term consequences on the TB burden. Excess deaths could skyrocket, with predictions suggesting an additional 1.4 million TB deaths attributable to the COVID-19 pandemic between 2020 and 2025.[3] The stage at which patients present is also changing, with patients diagnosed during the COVID-19 pandemic showing more extended pulmonary forms than ever before.[4] Moreover, there has been a rise in latent and active TB infections in children of infected patient households due to lockdown measures and isolation.[4]

It is still unclear as to whether the imposition of infectious control measures has helped stem TB transmission. Evidence suggests that transmission is reduced for both social distancing and mask-wearing, although it is unknown how strong these transmission-reducing effects might be on TB.[5] Various models adopted a central estimate of 50% for transmission reduction.[6] For severe disruptions (3-month lockdown and a 10-month restoration), results suggest that TB incidence could increase by 3%–9% between 2020 and 2025.[4]

To help mitigate the impact on treatment services and reduce crowding, 100 countries provided TB patients with a 1-month or more supply of anti-TB drugs at home.[1] Although effective as a short-term solution, longer regimens have been shown to reduce drug adherence rates in latent TB infection patients. In addition, the remote implementation of directly observed treatment by trained community workers could significantly improve treatment conclusions for these patients.[7]

The expanded use of remote advice and support, driven by the necessity for continuity of healthcare services, can solve long-term issues hampering TB eradication. The successful implementation of “telesalud” in Argentina shows us its potential benefit for TB services.[8] Teleconsultations improve access to care for patients with financial and geographical barriers, as well as reduce overhead costs for healthcare services.[9] Furthermore, it also allows patients to access care discreetly, mitigating personal and community stigma.

The pandemic has impacted health services, but it has also had severe negative implications on the global economy. Millions of precarious employments, reliant on sectors such as tourism, have become redundant. The World Bank estimates that a further 88–115 million people will be forced into extreme poverty,[10] a significant socioeconomic risk factor for TB. The rise in poverty has been met by a fall in nonmedical support services and national and international aid. 70% of Kenyan TB patients reported not receiving enough support during the pandemic.[11]

Furthermore, the significant economic contraction has forced countries to reallocate resources, originally meant for TB services, to the COVID-19 response. Although the COVID-19 response mechanism of the Global Fund has allocated the additional US $1 billion to help mitigate impacts on TB, HIV, and malaria,[12] it falls far short of the funding pledged by countries at the UN high-level meeting on TB in 2018. At last, the pandemic has significantly heightened interest and awareness in infectious respiratory disease. Therefore, the media must continue to highlight the disruption of TB services and the needs of TB patients to help push political commitment and investment to eradicate TB at a global, regional, and local level. Victory comes from finding opportunities in problems. Years of struggle combating TB cannot be lost in a single battle.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Global Tuberculosis Report 2020. Geneva, Switzerland: WHO; 2020.  Back to cited text no. 1
    
2.
Stoptb.org; 2021. Available from: http://www.stoptb.org/webadmin/cms/docs/Release%20for%20COVID%20and%20TB%202021%20report%20draft_16%20March_FINAL.pdf. [Last accessed on 2021 Sep 12].  Back to cited text no. 2
    
3.
India M. India TB Report 2021: Ministry of Health and Family Welfare; 2021. Available from: https://tbcindia.gov.in/showfile.php?lid=3587. [Last accessed on 2021 Sep 12].  Back to cited text no. 3
    
4.
Aznar ML, Espinosa-Pereiro J, Saborit N, Jové N, Sánchez Martinez F, Pérez-Recio S, et al. Impact of the COVID-19 pandemic on tuberculosis management in Spain. Int J Infect Dis 2021;108:300-5.  Back to cited text no. 4
    
5.
Cilloni L, Fu H, Vesga JF, Dowdy D, Pretorius C, Ahmedov S, et al. The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modeling analysis. EClinicalMedicine 2020;28:100603.  Back to cited text no. 5
    
6.
Driessche KV, Mahlobo PZ, Venter R, Caldwell J, Jennings K, Diacon AH, et al. Face masks in the post-COVID-19 era: A silver lining for the damaged tuberculosis public health response? Lancet Respir Med 2021;9:340-2.  Back to cited text no. 6
    
7.
Pradipta IS, Houtsma D, van Boven JF, Alffenaar JC, Hak E. Interventions to improve medication adherence in tuberculosis patients: A systematic review of randomized controlled studies. NPJ Prim Care Respir Med 2020;30:21.  Back to cited text no. 7
    
8.
Supporting Argentina's Regional Leadership in Telehealth; 2021. Available from: https://www.who.int/about/accountability/results/who-results-report-2020-mtr/country-story/2020/supporting-argentinas-regional-leadership-intelehealth. [Last accessed on 2021 Jul 27].  Back to cited text no. 8
    
9.
Gajarawala SN, Pelkowski JN. Telehealth benefits and barriers. J Nurse Pract 2021;17:218-21.  Back to cited text no. 9
    
10.
COVID-19 to Add as Many as 150 Million Extreme Poor by 2021. World Bank Group; 2021. Available from: https://www.worldbank.org/en/news/press-release/2020/10/07/covid-19-to-add-as-many-as-150-million-extreme-poor-by-2021. [Last accessed on 2021 Jul 27].  Back to cited text no. 10
    
11.
Stop TB Partnership Civil Society-Led TB/COVID-19 Working Group. The Impact of COVID-19 on the TB Epidemic: A Community Perspective. Geneva, Switzerland: Stop TB Partnership; 2020.  Back to cited text no. 11
    
12.
The Global Fund and COVID-19-Friends of the Global Fight. Friends of the Global Fight; 2021. Available from: https://www.theglobalfight.org/the-global-fund-and-covid-19/. [Last accessed on 2021 Jul 27].  Back to cited text no. 12
    




 

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