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Muniyandi M, Nagarajan K, Mathiyazhagan K, Giridharan P, Thiruvengadam K, Krishnan R. The Predicted Potential Impact of COVID-19 Pandemic on Tuberculosis Epidemic in Tamil Nadu, South India. Trop Med Infect Dis 2024; 9:12. [PMID: 38251209 PMCID: PMC10821053 DOI: 10.3390/tropicalmed9010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE To estimate the prevalence and incidence of TB before and during the COVID-19 pandemic in Tamil Nadu, south India. METHODS In the present study, the effect of COVID-19 epidemiology on the TB epidemic was assessed by the SEIR (Susceptible-Exposed-Infected-Recovered), a compartmental epidemiological model. The model input parameters on compartments of TB and incidence of COVID-19 were collected from the published literature. Based on the data collected, point prevalence and incidence of TB per 100,000 population is calculated with and without COVID-19. A prediction was conducted up to 2025, trend analysis was performed, and a trend chi-square test and chi-square test of independence were used to test the difference between the prevalence with and without COVID-19. R software 2000 (R 4.0.0) was used for analysis. RESULTS The TB prevalence without and with COVID-19 decreases from 289 in 2020 to 271 in 2025 and from 289 in 2020 to 269 in 2025, respectively. Similarly, the incidence of TB was decreasing from 144 in 2020 to 135 in 2025 without COVID-19 and 143 in 2020 to 134 in 2025 with COVID-19. Though the TB burden is decreasing over the years, the trend was not statistically significant (p > 0.05). With respect to the district level, the prevalence and incidence of TB with and without COVID-19 is also found to be decreasing over the years. It was also found that the difference in the prevalence and incidence of TB with and without COVID-19 was not statically significant. CONCLUSION The results of our study shows that there was an annual decline of around 2% from 2020 to 2025 in the trend of the prevalence and incidence of TB with and without COVID-19. Overall, there is a reduction, but it was not significant, and there is no significant effect of COVID-19 on TB in Tamil Nadu.
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Andre M, Lau LS, Pokharel MD, Ramelow J, Owens F, Souchak J, Akkaoui J, Ales E, Brown H, Shil R, Nazaire V, Manevski M, Paul NP, Esteban-Lopez M, Ceyhan Y, El-Hage N. From Alpha to Omicron: How Different Variants of Concern of the SARS-Coronavirus-2 Impacted the World. BIOLOGY 2023; 12:1267. [PMID: 37759666 PMCID: PMC10525159 DOI: 10.3390/biology12091267] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/07/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023]
Abstract
SARS-CoV-2, the virus that causes COVID-19, is prone to mutations and the generation of genetic variants. Since its first outbreak in 2019, SARS-CoV-2 has continually evolved, resulting in the emergence of several lineages and variants of concern (VOC) that have gained more efficient transmission, severity, and immune evasion properties. The World Health Organization has given these variants names according to the letters of the Greek Alphabet, starting with the Alpha (B.1.1.7) variant, which emerged in 2020, followed by the Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2), and Omicron (B.1.1.529) variants. This review explores the genetic variation among different VOCs of SARS-CoV-2 and how the emergence of variants made a global impact on the pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nazira El-Hage
- Herbert Wertheim College of Medicine, Biomedical Sciences Program Florida International University, Miami, FL 33199, USA; (M.A.); (L.-S.L.); (M.D.P.); (J.R.); (F.O.); (J.S.); (J.A.); (E.A.); (H.B.); (R.S.); (V.N.); (M.M.); (N.P.P.); (M.E.-L.); (Y.C.)
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Khader Y, Abaza H, Satyanarayana S, Abu Rumman AS, Alyousfi MN. Tuberculosis Notification in Jordan, 2016-2020. EPIDEMIOLOGIA 2023; 4:276-285. [PMID: 37489499 PMCID: PMC10366717 DOI: 10.3390/epidemiologia4030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023] Open
Abstract
The burden of tuberculosis (TB) in Jordan is largely unknown due to the paucity of high-quality data, under-reporting, and a lack of good quality vital registration system. This study aimed to assess the characteristics of TB patients in Jordan, determine the TB notification rate and assess the trend of TB notification in Jordan between 2016 and 2020. Methods: This study analyzed the TB Surveillance data in Jordan for the period 2016-2020. The obtained data included information on age, gender, nationality, marital status, date of symptoms onset and date of diagnosis, and site of TB. Results: During the period 2016-2020, a total of 1711 patients (989 women and 722 men) were diagnosed with and treated for tuberculosis. The mean (SD) age of patients was 30.1 (17.2) years. Almost half of them (48.4%) were Jordanians. The majority of non-Jordanian patients were from Syria, Philippines, and Bangladesh. Two thirds of patients (66.0%) had pulmonary TB and 34.0% had extra-pulmonary TB. Almost half (50.7%) of the patients were diagnosed within one month of the symptoms' onset. The average annual TB notification rate during 2016-2020 was 3.32 per 100,000 pop (4.08 per 100,000 women and 2.64 per 100,000 men). The average annual standardized notification rate was 4.13 per 100,000 pop (4.52 per 100,000 women and 3.52 per 100,000 men). The overall age-standardized notification rate increased from 3.88 per 100,000 pop in 2016 to 4.58 per 100,000 pop in 2019 and declined to 2.46 per 100,000 pop in 2020. The trend in TB notification differed significantly according to gender. While the notification increased in the last three years among women, it decreased significantly among men. Conclusions: While TB notification increased in the last three years among women, it decreased significantly among men. There is a need to ensure that the national TB plans set clear targets for reducing the burden of TB.
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Affiliation(s)
- Yousef Khader
- Center of Excellence for Applied Epidemiology, Global Health Development, Eastern Mediterranean Public Health Network, Amman 11195, Jordan
| | - Hiba Abaza
- Migration Health Division, International Organization for Migration (IOM), Amman 11953, Jordan
| | - Srinath Satyanarayana
- Migration Health Division, International Organization for Migration (IOM), Amman 11953, Jordan
| | - Ahmad Saleh Abu Rumman
- Department of Chest Disease and Foreigners, Jordan Ministry of Health, Amman 11118, Jordan
| | - Mohamad Nihad Alyousfi
- Center of Excellence for Applied Epidemiology, Global Health Development, Eastern Mediterranean Public Health Network, Amman 11195, Jordan
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Shewade HD, Frederick A, Kiruthika G, Kalyanasundaram M, Chadwick J, Rajasekar TD, Gayathri K, Vijayaprabha R, Sabarinathan R, Kathiresan J, Bhavani P, Aarthi S, Suma K, Pathinathan DP, Parthasarathy R, Nivetha MB, Thampi JG, Chidambaram D, Bhatnagar T, Lokesh S, Devika S, Laux TS, Viswanathan S, Sridhar R, Krishnamoorthy K, Sakthivel M, Karunakaran S, Rajkumar S, Ramachandran M, Kanagaraj K, Kaleeswari M, Durai V, Saravanan R, Sugantha A, Khan SZHM, Sangeetha P, Vasudevan R, Nedunchezhian R, Sankari M, Jeevanandam N, Ganapathy S, Rajasekaran V, Mathavi T, Rajaprakash A, Murali L, Pugal U, Sundaralingam K, Savithri S, Vellasamy S, Dheenadayal D, Ashok P, Jayasree K, Sudhakar R, Rajan K, Tharageshwari N, Chokkalingam D, Anandrajkumar S, Selvavinayagam T, Padmapriyadarshini C, Ramachandran R, Murhekar MV. The First Differentiated TB Care Model From India: Delays and Predictors of Losses in the Care Cascade. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200505. [PMID: 37116929 PMCID: PMC10141439 DOI: 10.9745/ghsp-d-22-00505] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
To reduce TB deaths in resource-limited settings, a differentiated care strategy can be used to triage patients with high risk of severe illness (i.e., those with very severe undernutrition, respiratory insufficiency, or inability to stand without support) at diagnosis and refer them for comprehensive assessment and inpatient care. Globally, there are few examples of implementing this type of strategy in routine program settings. Beginning in April 2022, the Indian state of Tamil Nadu implemented a differentiated care strategy called Tamil Nadu-Kasanoi Erappila Thittam (TN-KET) for all adults aged 15 years and older with drug-susceptible TB notified by public facilities. Before evaluating the impact on TB deaths, we sought to understand the retention and delays in the care cascade as well as predictors of losses. During April-June 2022, 14,961 TB patients were notified and 11,599 (78%) were triaged. Of those triaged, 1,509 (13%) were at high risk of severe illness; of these, 1,128 (75%) were comprehensively assessed at a nodal inpatient care facility. Of 993 confirmed as severely ill, 909 (92%) were admitted, with 8% unfavorable admission outcomes (4% deaths). Median admission duration was 4 days. From diagnosis, the median delay in triaging and admission of severely ill patients was 1 day each. Likelihood of triaging decreased for people with extrapulmonary TB, those diagnosed in high-notification districts or teaching hospitals, and those transferred out of district. Predictors of not being comprehensively assessed included: aged 25-34 years, able to stand without support, and diagnosis at a primary or secondary-level facility. Inability to stand without support was a predictor of unfavorable admission outcomes. To conclude, the first quarter of implementation suggests that TN-KET was feasible to implement but could be improved by addressing predictors of losses in the care cascade and increasing admission duration.
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Affiliation(s)
- Hemant Deepak Shewade
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - G. Kiruthika
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - Joshua Chadwick
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - T. Daniel Rajasekar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - K. Gayathri
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - R. Vijayaprabha
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - R. Sabarinathan
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - Jeyashree Kathiresan
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - P.K. Bhavani
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - S. Aarthi
- State TB Cell, Government of Tamil Nadu, Chennai, India
| | - K.V. Suma
- World Health Organization Country Office for India, New Delhi, India
| | | | | | | | - Jerome G. Thampi
- World Health Organization Country Office for India, New Delhi, India
| | | | - Tarun Bhatnagar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - S. Lokesh
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | | | - Stalin Viswanathan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - R. Sridhar
- Government Hospital of Thoracic Medicine, Tambaram, India
| | | | - M. Sakthivel
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Karunakaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Rajkumar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Ramachandran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K.D. Kanagaraj
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Kaleeswari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V.P. Durai
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Saravanan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A. Sugantha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - P. Sangeetha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Vasudevan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Nedunchezhian
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Sankari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - N. Jeevanandam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Ganapathy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V. Rajasekaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - T. Mathavi
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A.R. Rajaprakash
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - Lakshmi Murali
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - U. Pugal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Sundaralingam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Savithri
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Vellasamy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - D. Dheenadayal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - P. Ashok
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Jayasree
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Sudhakar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K.P. Rajan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - D. Chokkalingam
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - T.S. Selvavinayagam
- Directorate of Public Health and Preventive Medicine, Government of Tamil Nadu, Chennai, India
| | - C. Padmapriyadarshini
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | | | - Manoj V. Murhekar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
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McQuaid CF, Sinha P, Bhargava M, Weerasuriya C, Houben RMGJ, Bhargava A. Tuberculosis and nutrition: what gets measured gets managed. THE LANCET. RESPIRATORY MEDICINE 2023; 11:308-310. [PMID: 36870352 DOI: 10.1016/s2213-2600(23)00009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 01/06/2023] [Indexed: 03/05/2023]
Affiliation(s)
- C Finn McQuaid
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Pranay Sinha
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Madhavi Bhargava
- Department of Community Medicine, Yenepoya University, Mangalore, India; Center for Nutrition Studies, Yenepoya University, Mangalore, India
| | - Chathika Weerasuriya
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rein M G J Houben
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Anurag Bhargava
- Center for Nutrition Studies, Yenepoya University, Mangalore, India; Department of Medicine, Yenepoya Medical College Hospital, Yenepoya University, Mangalore, India; Department of Medicine, McGill University, Montreal, QC, Canada
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Jeong Y, Min J. Impact of COVID-19 Pandemic on Tuberculosis Preventive Services and Their Post-Pandemic Recovery Strategies: A Rapid Review of Literature. J Korean Med Sci 2023; 38:e43. [PMID: 36747365 PMCID: PMC9902666 DOI: 10.3346/jkms.2023.38.e43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/14/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic has disrupted tuberculosis (TB) care and prevention around the world. The aim of this study is to review literature on the impact of COVID-19 on TB preventive services and discuss their policy options during and after the pandemic. METHODS We conducted a rapid review of scientific literature on the impact of COVID-19 on TB preventive services and their recovery strategies. After conducting a line-by-line open coding, their codes were applied in the descriptive theme building process, which was guided by the End TB strategy. TB preventive measures were selected and classified into five analytical categories: 1) vaccination against TB, 2) detection and treatment of latent TB infection (LTBI), 3) screening and diagnostics, 4) active case finding and contact tracing, and 5) surveillance. RESULTS We identified 93 articles, of which 65 were research articles. During the pandemic, we observed decrease in Bacillus Calmette-Guérin (BCG) coverage, TB diagnostic services, case finding activities, and LTBI management. TB case detection was declined, which was not resumed to the pre-pandemic level after loosening the lock-down. Several recommendations were highlighted: 1) secure BCG stocks and its supply chains, 2) consider catch-up activities of routine immunization and LTBI screening, 3) maintain minimal TB health services, infection prevention and control, and surveillance, 4) leverage laboratory capacity and contact tracing mechanisms, 5) consider simultaneous testing for TB and COVID-19, and 6) Incorporate digital health technologies. CONCLUSIONS Our findings and lessons learnt from the pandemic can aid in the development of future national TB control program.
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Affiliation(s)
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Zheng Y, Emam M, Lu D, Tian M, Wang K, Peng X. Analysis of the effect of temperature on tuberculosis incidence by distributed lag non-linear model in Kashgar city, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:11530-11541. [PMID: 36094714 PMCID: PMC9466343 DOI: 10.1007/s11356-022-22849-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to explore the effect of temperature on tuberculosis (TB) incidence using the distributed lag non-linear model (DLNM) from 2017 to 2021 in Kashgar city, the region with higher TB incidence than national levels, and assist public health prevention and control measures. From January 2017 to December 2021, a total of 8730 cases of TB were reported, with the higher incidence of male than that of female. When temperature was below 1 °C, it was significantly correlated with TB incidence compared to the median observed temperature (15 °C) at lag 7, 14, and 21, and lower temperatures showed larger RR (relative risk) values. High temperature produced a protective effect on TB transmission, and higher temperature from 16 to 31 °C has lower RR. In discussion stratified by gender, the maximum RRs were achieved for both male group and female group at - 15 °C with lag 21, reporting 4.28 and 2.02, respectively. At high temperature (higher than 20 °C), the RR value of developing TB for female group was significantly larger than 1. In discussion stratified by age, the maximum RRs were achieved for all age groups (≤ 35, 36-64, ≥ 65) at - 15 °C with lag 21, reporting 3.20, 2.07, and 3.45, respectively. When the temperature was higher than 20 °C, the RR of the 36-64-year-old group and the ≥ 65-year-old group was significantly larger than 1 at lag 21, while significantly smaller than 1 for cumulative RR at lag 21, reporting 0.11, 95% confidence interval (CI) (0.01, 0.83) and 0.06, 95% CI (0.01, 0.44), respectively. In conclusion, low temperature, especially in extreme level, acts as a high-risk factor inducing TB transmission in Kashgar city. Males exhibit a significantly higher RR of developing TB at low temperature than female, as well as the elderly group in contrast to the young or middle-aged groups. High temperature has a protective effect on TB transmission in the total population, but female and middle-aged and elderly groups are also required to be alert to the delayed RR induced by it.
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Affiliation(s)
- Yanling Zheng
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, 830017, China.
| | - Mawlanjan Emam
- Center for Disease Control and Prevention, Kashgar, China
| | - Dongmei Lu
- Center of Respiratory and Critical Care Medicine of the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Maozai Tian
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, 830017, China
| | - Kai Wang
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, 830017, China
| | - Xiaowang Peng
- Center for Disease Control and Prevention, Kashgar, China.
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Khader Y, Abaza H, Satyanarayana S, Abu Rumman AS, Alyousfi MN. Tuberculosis notification in Jordan, 2016-2020 (Preprint). JMIR Public Health Surveill 2022. [DOI: 10.2196/43751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Shewade HD, Nagaraja SB, Vanitha B, Murthy HJD, Bhargava M, Singarajipura A, Shastri SG, Patel BH, Davara K, Reddy RC, Kumar AMV, Bhargava A. Screening for Severe Illness at Diagnosis Has the Potential to Prevent Early TB Deaths: Programmatic Experience From Karnataka, India. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00736. [PMID: 36041840 PMCID: PMC9426979 DOI: 10.9745/ghsp-d-21-00736] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/03/2022] [Indexed: 11/20/2022]
Abstract
Despite TB being a potentially fatal disease, severity is not systematically assessed at the start of drug-susceptible TB treatment. We document our experience screening people for severe illness at diagnosis/notification in program settings and the potential impact on reducing early TB deaths. Due to the coronavirus disease (COVID-19) pandemic and its associated response, TB deaths increased for the first time in a decade. In any potentially fatal illness, an assessment of severity is essential. This is not systematically done for adults with TB, mostly due to a lack of policy and/or limited availability of diagnostic and clinical capacity. We developed a screening tool using simple and easily measurable indicators that can be used by paramedical TB program staff to quickly identify people with severe illness. During October–November 2020 in Karnataka, India, the paramedical program staff from 16 districts screened people with TB (aged ≥15 years) notified by public facilities for “high risk of severe illness,” which was defined as the presence of any of the following indicators: (1) body mass index (BMI) ≤14.0 kg/m2; (2) BMI ≤16.0 kg/m2 with bilateral leg swelling; (3) respiratory rate >24/minute; (4) oxygen saturation <94%; (5) inability to stand without support. In this cohort study, we determined the incidence of program-recorded early deaths (within 2 months) and its association with high risk of severe illness. Of 3,010 people with TB, 1,529 (50.8%) were screened at diagnosis/notification, of whom 537 (35.1%) had a high risk of severe illness. There were 195 (6.5%, 95% CI=5.7, 7.4) early deaths: 59 (30.2%) within a week and 100 (51.3%) within 2 weeks of treatment initiation. The incidence of early deaths was significantly higher among those with high risk of severe illness (8.9%) at diagnosis compared to those without (3.8%) [adjusted relative risk: 2.36 (95% confidence interval=1.57, 3.55)]. To conclude, early deaths were especially high during the first 2 weeks and strongly associated with a high risk of severe illness at diagnosis/notification. Screening for severe illness should be explored as a potential strategy to end TB deaths.
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Affiliation(s)
| | | | | | | | - Madhavi Bhargava
- Centre for Nutrition Studies, Yenepoya (Deemed to be University), Mangaluru, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
| | - Anil Singarajipura
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | - Suresh G Shastri
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | | | - Kajal Davara
- Community Medicine Department, GMERS Medical College, Vadodara, India
| | - Ramesh Chandra Reddy
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | - Ajay M V Kumar
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South-East Asia Office, New Delhi, India
| | - Anurag Bhargava
- Centre for Nutrition Studies, Yenepoya (Deemed to be University), Mangaluru, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
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Trajman A, Felker I, Alves LC, Coutinho I, Osman M, Meehan SA, Singh UB, Schwartz Y. The COVID-19 and TB syndemic: the way forward. Int J Tuberc Lung Dis 2022; 26:710-719. [PMID: 35898126 PMCID: PMC9341497 DOI: 10.5588/ijtld.22.0006] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Together, SARS-CoV-2 and M. tuberculosis have killed approximately 5.7 million people worldwide over the past 2 years. The COVID-19 pandemic, and the non-pharmaceutical interventions to mitigate COVID-19 transmission (including social distancing regulations, partial lockdowns and quarantines), have disrupted healthcare services and led to a reallocation of resources to COVID-19 care. There has also been a tragic loss of healthcare workers who succumbed to the disease. This has had consequences for TB services, and the fear of contracting COVID-19 may also have contributed to reduced access to TB services. Altogether, this is projected to have resulted in a 5-year setback in terms of mortality from TB and a 9-year setback in terms of TB detection. In addition, past and present TB disease has been reported to increase both COVID-19 fatality and incidence. Similarly, COVID-19 may adversely affect TB outcomes. From a more positive perspective, the pandemic has also created opportunities to improve TB care. In this review, we highlight similarities and differences between these two infectious diseases, describe gaps in our knowledge and discuss solutions and priorities for future research.
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Affiliation(s)
- A Trajman
- Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil, Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - I Felker
- WHO Collaborating Centre, Novosibirsk Tuberculosis Research Institute, Novosibirsk, Russian Federation
| | - L C Alves
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA
| | - I Coutinho
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, School of Human Sciences, Faculty of Education, Health & Human Sciences, University of Greenwich, London, UK
| | - S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - U B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Y Schwartz
- WHO Collaborating Centre, Novosibirsk Tuberculosis Research Institute, Novosibirsk, Russian Federation
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11
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Jeyashree K, Thangaraj J, Rade K, Modi B, Selvaraju S, Velusamy S, Akhil S, Vijayageetha M, Sudha Rani D, Sabarinathan R, Manikandanesan S, Elumalai R, Natarajan M, Joseph B, Mahapatra A, Shamim A, Shah A, Bhardwaj A, Purty A, Vadera B, Sridhar A, Chowdhury A, Shafie A, Choudhury A, Dhrubjyoti D, Solanki H, Sirmanwar K, Khaparde K, Parmar M, Dahiya N, Debdutta P, Ahmed Q, Ramachandran R, Prasad R, Shinde R, Baruah R, Chauhan S, Bharaswadkar S, Achanta S, Sharath BN, Balakrishnan S, Chandra S, Khumukcham S, Mandal S, Chalil S, Shah V, Roddawar V, Rao R, Sachdeva K, Murhekar M. Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015-2020. BMJ Open 2022; 12:e060197. [PMID: 35902192 PMCID: PMC9340578 DOI: 10.1136/bmjopen-2021-060197] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India. DESIGN A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data. SETTING National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status. PARTICIPANTS Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district. OUTCOME MEASURES We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015. RESULTS The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra. CONCLUSION TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020.
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Affiliation(s)
| | - Jeromie Thangaraj
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Kiran Rade
- World Health Organization, Country Office for India, New Delhi, India
| | - Bhavesh Modi
- GMERS Medical College & Civil Hospital, Gandhinagar, Gujarat, India
| | - Sriram Selvaraju
- ICMR - National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - Sasidharan Akhil
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | | | | | | | | | | | - Bency Joseph
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Almas Shamim
- WHO-NTEP Technical Assistance Project, New Delhi, India
| | - Amar Shah
- USAID India Mission, New Delhi, Delhi, India
| | - Ashok Bhardwaj
- MM Medical College & Hospital, Kumarhatti, Solan, Himachal Pradesh, India
| | - Anil Purty
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Bhavin Vadera
- Wadhwani Institute of Artificial Intelligence, Mumbai, India
| | - Anand Sridhar
- WHO-NTEP Technical Assistance Project, New Delhi, India
| | | | - Asif Shafie
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Avijit Choudhury
- World Health Organization, Country Office for India, New Delhi, India
| | | | | | | | | | - Malik Parmar
- World Health Organization, Country Office for India, New Delhi, India
| | - Nisha Dahiya
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | | | | | | | - Ranjeet Prasad
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Rohini Shinde
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | | | | | | | | | | | | | | | | | - Sudarsan Mandal
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | | | - Vaibhav Shah
- WHO-NTEP Technical Assistance Project, New Delhi, India
| | | | - Raghuram Rao
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Kuldeep Sachdeva
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Manoj Murhekar
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
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12
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Yadav S. Starting an All-Oral Longer Regimen in a Primary Multidrug-Resistant Pulmonary Tuberculosis Patient at a District Tuberculosis Center for the First Time: A Rare Case. Cureus 2022; 14:e27146. [PMID: 36004032 PMCID: PMC9392847 DOI: 10.7759/cureus.27146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis (TB) is a disease known to mankind for ages. The situation due to this infection in low- and middle-income countries is grave. The coronavirus disease 2019 (COVID-19) pandemic has only added up to the woes. The situation is alarming due to the isolation of drug-resistant Mycobacterium strains in patients with no history of TB. With the inclusion of new drugs for the management of TB, such as bedaquiline (Bdq), prompt diagnosis and management are feasible. The author herein presents the first case of a primary multidrug-resistant pulmonary TB patient managed on an all-oral longer regimen with Bdq started at a district TB center (DTC) for the first time in the pandemic of COVID-19. This case is unique as during the COVID-19 pandemic, healthcare facilities were saturated, and thus starting treatment after admission was very difficult. Also, the chances of cross-infection in TB patients were present due to weak immunity. This case is very important as this novel management at a DTC would help immensely in resource-limited countries where hospital admissions are difficult due to the COVID-19 pandemic and the burden of TB is very high.
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13
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Tovar M, Aleta A, Sanz J, Moreno Y. Modeling the impact of COVID-19 on future tuberculosis burden. COMMUNICATIONS MEDICINE 2022; 2:77. [PMID: 35784445 PMCID: PMC9243113 DOI: 10.1038/s43856-022-00145-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/16/2022] [Indexed: 01/09/2023] Open
Abstract
Background The ongoing COVID-19 pandemic has greatly disrupted our everyday life, forcing the adoption of non-pharmaceutical interventions in many countries and putting public health services and healthcare systems worldwide under stress. These circumstances are leading to unintended effects such as the increase in the burden of other diseases. Methods Here, using a data-driven epidemiological model for tuberculosis (TB) spreading, we describe the expected rise in TB incidence and mortality if COVID-associated changes in TB notification are sustained and attributable entirely to disrupted diagnosis and treatment adherence. Results Our calculations show that the reduction in diagnosis of new TB cases due to the COVID-19 pandemic could result in 228k (CI 187-276) excess deaths in India, 111k (CI 93-134) in Indonesia, 27k (CI 21-33) in Pakistan, and 12k (CI 9-18) in Kenya. Conclusions We show that it is possible to reverse these excess deaths by increasing the pre-covid diagnosis capabilities from 15 to 50% for 2 to 4 years. This would prevent almost all TB-related excess mortality that could be caused by the COVID-19 pandemic if no additional preventative measures are introduced. Our work therefore provides guidelines for mitigating the impact of COVID-19 on tuberculosis epidemic in the years to come.
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Affiliation(s)
- Mario Tovar
- grid.11205.370000 0001 2152 8769Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, 50009 Zaragoza, Spain ,grid.11205.370000 0001 2152 8769Department of Theoretical Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - Alberto Aleta
- grid.418750.f0000 0004 1759 3658ISI Foundation, Via Chisola 5, 10126 Torino, Italy
| | - Joaquín Sanz
- grid.11205.370000 0001 2152 8769Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, 50009 Zaragoza, Spain ,grid.11205.370000 0001 2152 8769Department of Theoretical Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - Yamir Moreno
- grid.11205.370000 0001 2152 8769Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, 50009 Zaragoza, Spain ,grid.11205.370000 0001 2152 8769Department of Theoretical Physics, University of Zaragoza, 50009 Zaragoza, Spain ,grid.418750.f0000 0004 1759 3658ISI Foundation, Via Chisola 5, 10126 Torino, Italy
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14
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Dheda K, Perumal T, Moultrie H, Perumal R, Esmail A, Scott AJ, Udwadia Z, Chang KC, Peter J, Pooran A, von Delft A, von Delft D, Martinson N, Loveday M, Charalambous S, Kachingwe E, Jassat W, Cohen C, Tempia S, Fennelly K, Pai M. The intersecting pandemics of tuberculosis and COVID-19: population-level and patient-level impact, clinical presentation, and corrective interventions. THE LANCET. RESPIRATORY MEDICINE 2022; 10:603-622. [PMID: 35338841 PMCID: PMC8942481 DOI: 10.1016/s2213-2600(22)00092-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 01/19/2023]
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.
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Affiliation(s)
- Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa; Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Tahlia Perumal
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Harry Moultrie
- Centre for TB, National Institute for Communicable Diseases, Division of the National Health Laboratory Services, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rubeshan Perumal
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; SAMRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Alex J Scott
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Zarir Udwadia
- Department of Pulmonology, P D Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Kwok Chiu Chang
- Tuberculosis and Chest Service, Department of Health, Hong Kong Special Administrative Region, China
| | - Jonathan Peter
- Allergy and Immunology unit, Division of Allergy and Clinical Immunology, University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Anil Pooran
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Arne von Delft
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; TB Proof, Cape Town, South Africa
| | | | - Neil Martinson
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Johns Hopkins University Center for TB Research, Baltimore, MD, USA
| | - Marian Loveday
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Salome Charalambous
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The Aurum Institute, Johannesburg, South Africa
| | - Elizabeth Kachingwe
- Centre for TB, National Institute for Communicable Diseases, Division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Waasila Jassat
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Cheryl Cohen
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Stefano Tempia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Kevin Fennelly
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, QC, Canada
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15
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Manhiça I, Augusto O, Sherr K, Cowan J, Cuco RM, Agostinho S, Macuacua BC, Ramiro I, Carimo N, Matsinhe MB, Gloyd S, Chicumbe S, Machava R, Tembe S, Fernandes Q. COVID-19-related healthcare impacts: an uncontrolled, segmented time-series analysis of tuberculosis diagnosis services in Mozambique, 2017-2020. BMJ Glob Health 2022; 7:bmjgh-2021-007878. [PMID: 35443938 PMCID: PMC9021460 DOI: 10.1136/bmjgh-2021-007878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/27/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Currently, COVID-19 dominates the public health agenda and poses a permanent threat, leading to health systems’ exhaustion and unprecedented service disruption. Primary healthcare services, including tuberculosis services, are at increased risk of facing severe disruptions, particularly in low-income and middle-income countries. Indeed, corroborating model-based forecasts, there is increasing evidence of the COVID-19 pandemic’s negative impact on tuberculosis case detection. Methods Applying a segmented time-series analysis, we assessed the effects of COVID-19-related measures on tuberculosis diagnosis service across districts in Mozambique. Ministry health information system data were used from the first quarter of 2017 to the end of 2020. The model, performed under the Bayesian premises, was estimated as a negative binomial with random effects for districts and provinces. Results A total of 154 districts were followed for 16 consecutive quarters. Together, these districts reported 96 182 cases of all forms of tuberculosis in 2020. At baseline (first quarter of 2017), Mozambique had an estimated incidence rate of 283 (95% CI 200 to 406) tuberculosis cases per 100 000 people and this increased at a 5% annual rate through the end of 2019. We estimated that 17 147 new tuberculosis cases were potentially missed 9 months after COVID-19 onset, resulting in a 15.1% (95% CI 5.9 to 24.0) relative loss in 2020. The greatest impact was observed in the southern region at 40.0% (95% CI 30.1 to 49.0) and among men at 15% (95% CI 4.0 to 25.0). The incidence of pulmonary tuberculosis increased at an average rate of 6.6% annually; however, an abrupt drop (15%) was also observed immediately after COVID-19 onset in March 2020. Conclusion The most significant impact of the state of emergency was observed between April and June 2020, the quarter after COVID-19 onset. Encouragingly, by the end of 2020, clear signs of health system recovery were visible despite the initial shock.
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Affiliation(s)
| | - Orvalho Augusto
- Saude da Comunidade, Faculdade de Medicina, Cidade de Maputo, Mozambique.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James Cowan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | | | - Isaías Ramiro
- Comité para a Saúde de Moçambique, Maputo City, Mozambique
| | - Naziat Carimo
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Stélio Tembe
- Ministerio da Saude, Maputo, Mozambique.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Quinhas Fernandes
- Ministerio da Saude, Maputo, Mozambique .,Department of Global Health, University of Washington, Seattle, Washington, USA
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16
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Digital Storytelling and Community Engagement to Find Missing TB Cases in Rural Nuh, India. Trop Med Infect Dis 2022; 7:tropicalmed7030049. [PMID: 35324596 PMCID: PMC8955008 DOI: 10.3390/tropicalmed7030049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
Nuh, Haryana, is one of India’s least developed districts. To improve TB case notifications, ZMQ carried out an active case-finding (ACF) intervention conducted by community health workers (MIRAs) using a digital TB storytelling platform to create TB awareness in the community. The combined storytelling and ACF intervention were conducted house-to-house or in community group settings. Steps included (A) the development of digital TB awareness-raising stories using a participatory approach called Story Labs; (B) the implementation of the intervention; and (C) process, outcome, and impact evaluation of these activities. Six digital stories were created and used during ACF in which 19,345 people were screened and 255 people were diagnosed with TB. Of 731 participants surveyed, the stories were well received and resulted in an increase in TB knowledge. ACF activities resulted in a 56% increase in bacteriologically confirmed TB and an 8% decrease in all forms of TB compared to baseline. All form notifications may have been impacted by COVID-19 lockdowns. Digital TB storytelling can improve TB awareness and knowledge, particularly for low-literacy populations. The use of these tools may benefit ACF campaigns and improve TB case finding.
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17
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Darnton-Hill I, Mandal PP, de Silva A, Bhatia V, Sharma M. Opportunities to prevent and manage undernutrition to amplify efforts to end TB. Int J Tuberc Lung Dis 2022; 26:6-11. [PMID: 34969422 PMCID: PMC8734190 DOI: 10.5588/ijtld.21.0488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The bidirectional relationship between TB and nutrition is well recognized - primary undernutrition is a risk factor for developing TB disease, while TB results in wasting. Although nutrition support is acknowledged as an important intervention in TB programmes, it is seldom afforded commensurate priority for action. TB incidence and deaths worldwide are falling too slowly to meet WHO End TB Strategy milestones, and the number of undernourished people is increasing, likely to be further exacerbated by the ongoing COVID-19 pandemic. Undernutrition needs to be more urgently and intensively addressed. This is especially true for the WHO South-East Asia Region, where the high rates of undernutrition are a key driver of the TB epidemic. The evidence base has been sufficiently robust for clear and workable programmatic guidance to be formulated on assessment, counselling and interventions for TB patients. Many high-burden countries have developed policies addressing TB and nutrition. Gaps in research to date have frustrated the development of more refined programmatic approaches related to addressing TB and malnutrition. Future research can be shaped to inform targeted, actionable policies and programmes delivering dual benefits in terms of undernutrition and TB. There are clear opportunities for policy-makers to amplify efforts to end TB by addressing undernutrition.
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Affiliation(s)
- I Darnton-Hill
- The Boden Collaboration on Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW, Australia
| | - P P Mandal
- Tuberculosis Unit, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - A de Silva
- Nutrition and Health for Development Unit, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - V Bhatia
- Tuberculosis Unit, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - M Sharma
- Tuberculosis Unit, World Health Organization Regional Office for South-East Asia, New Delhi, India
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18
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Martin-Hughes R, Vu L, Cheikh N, Kelly SL, Fraser-Hurt N, Shubber Z, Manhiça I, Mbendera K, Girma B, Pambudi I, Ríos J, Elmira A, Harimurti P, Hafez R, Garcia JNB, Palmer T, Roberts A, Gorgens M, Wilson D. Impacts of COVID-19-related service disruptions on TB incidence and deaths in Indonesia, Kyrgyzstan, Malawi, Mozambique, and Peru: Implications for national TB responses. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000219. [PMID: 36962192 PMCID: PMC10021439 DOI: 10.1371/journal.pgph.0000219] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/02/2022] [Indexed: 11/18/2022]
Abstract
Initial global-level estimates reported in June 2020 by the World Health Organization suggested that levels of disruption to TB service delivery could be as high as 25%-50% and result in an additional 6·3 million cases of tuberculosis (TB) and an additional 1·4 million TB-related deaths attributable to COVID-19 between 2020 and 2025. Quarterly epidemiological estimates and programmatic TB data capturing disruption levels to each TB service were collected by National TB Programmes in Indonesia, Kyrgyzstan, Malawi, Mozambique, and Peru. Data from 2019, for a pre-COVID-19 baseline, and throughout 2020, together with the NTP's COVID-19 response plans, were used within Optima TB models to project TB incidence and deaths over five years because of COVID-19-related disruptions, and the extent to which those impacts may be mitigated through proposed catch-up strategies in each country. Countries reported disruptions of up to 64% to demand-driven TB diagnosis. However, TB service availability disruptions were shorter and less severe, with TB treatment experiencing levels of disruption of up to 21%. We predicted that under the worse-case scenario cumulative new latent TB infections, new active TB infections, and TB-related deaths could increase by up to 23%, 11%, and 20%, respectively, by 2024. However, three of the five countries were on track to mitigate these increases to 3% or less by maintaining TB services in 2021 and 2022 and by implementing proposed catch-up strategies. Indonesia was already experiencing the worse-case scenario, which could lead to 270,000 additional active TB infections and 36,000 additional TB-related deaths by the end of 2024. The COVID-19 pandemic is projected to negatively affect progress towards 2035 End TB targets, especially in countries already off-track. Findings highlight both successful TB service delivery adaptions in 2020 and the need to proactively maintain TB service availability despite potential future waves of more transmissible COVID-19 variants.
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Affiliation(s)
| | - Lung Vu
- The World Bank, N.W. Washington, DC, United States of America
| | - Nejma Cheikh
- The World Bank, N.W. Washington, DC, United States of America
| | | | | | - Zara Shubber
- The World Bank, N.W. Washington, DC, United States of America
| | | | | | | | - Imran Pambudi
- NTP Indonesia, Ministry of Health, Jakarta Selatan, Indonesia
| | - Julia Ríos
- NTP Peru, Ministry of Health, Jesús María, Lima, Peru
| | | | - Pandu Harimurti
- The World Bank, N.W. Washington, DC, United States of America
| | - Reem Hafez
- The World Bank, N.W. Washington, DC, United States of America
| | | | - Tom Palmer
- Institute for Global Health, University College London, London, United Kingdom
| | - Anna Roberts
- Burnet Institute, Melbourne, Victoria, Australia
| | | | - David Wilson
- The World Bank, N.W. Washington, DC, United States of America
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19
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Gandhi AP, Kathirvel S, Rehman T. Effect of COVID-19 lockdown on the pathway of care and treatment outcome among patients with tuberculosis in a rural part of northern India: a community-based study. J Rural Med 2022; 17:59-66. [PMID: 35432638 PMCID: PMC8984619 DOI: 10.2185/jrm.2021-039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives: The coronavirus disease 2019 (COVID-19) pandemic affected
routine healthcare services across all spectra, and tuberculosis (TB) care under the
National Tuberculosis Elimination Program have been affected the most. However, evidence
available at the community level is minimal. The clinical features, care cascade pathway,
and treatment outcomes of TB patients pre- and during/post-COVID-19 pandemic lockdown in a
rural community health block in northern India were assessed and compared. Materials and Methods: This was a retrospective cohort study that included
all patients diagnosed with TB and initiated treatment under programmatic settings between
January 1 and June 30, 2020, in a rural TB unit in northern India. The periods from
January 1 to March 23 and March 24 to June 30 were marked as pre-lockdown and
during/post-lockdown, respectively. Results: A total of 103 patients were diagnosed and treated for TB during
the study period. A significantly higher proportion of pulmonary TB cases were reported
during/post-lockdown (43, 82.7%) compared to that pre-lockdown (32, 62.7%), and a higher
diagnostic delay was noted during/post-lockdown (35, 81.4%). Through adjusted analysis,
patients diagnosed during/post-lockdown period (adjusted risk ratio [aRR], 0.85; 95%
confidence interval [CI], 0.73–0.98) and previously treated (aRR, 0.77; 95% CI,
0.60–0.995) had significantly lower favorable treatment outcomes. Conclusions: The symptom and disease (pulmonary/extrapulmonary) pattern have
changed during/post-lockdown. The care cascade delays are still high among TB patients,
irrespective of the lockdown status. Lockdown had a significant adverse impact on the
outcomes of TB treatment.
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Affiliation(s)
- Aravind Periyasamy Gandhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, India
| | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, India
| | - Tanveer Rehman
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, India
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20
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Chapman HJ, Veras-Estévez BA. Lessons Learned During the COVID-19 Pandemic to Strengthen TB Infection Control: A Rapid Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:964-977. [PMID: 34933990 PMCID: PMC8691887 DOI: 10.9745/ghsp-d-21-00368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023]
Abstract
In light of competing health priorities of COVID-19 and TB, we propose recommendations to strengthen health system preparedness for optimal TB control across low- and middle-income countries during and after the COVID-19 pandemic. Introduction: Over the past 5 years, substantial global investment has resulted in reduced TB incidence rates by 9% and mortality rates by 14%. However, the coronavirus disease (COVID-19) pandemic has hindered access and availability of TB services to maintain robust TB control. The objective of this rapid review was to describe the challenges to be addressed and recommendations to strengthen health system preparedness for optimal TB control across low- and middle-income countries during and after the COVID-19 pandemic. Methods: Five databases were used to systematically search for relevant articles published in 2020. The 5-step framework proposed by Arskey and O'Malley and adapted by Levac et al. guided the review process. Thematic analysis with grounded theory principles was used to summarize themes from selected articles and integrate analyses with barriers reported from authors' previous TB research. Results: Of the 218 peer-reviewed articles, 20 articles met the inclusion criteria. Four emerging themes described challenges: (1) unprepared health system leadership and infrastructure, (2) coexisting health priorities, (3) insufficient health care workforce support for continued training and appropriate workplace environments, and (4) weak connections to primary health centers hindering community engagement. Four recommendations were highlighted: (1) ensuring leadership and governance for sustainable national health budgets, (2) building networks of community stakeholders, (3) supporting health care workforce training and safe workplace environments, and (4) using digital health interventions for TB care. Conclusions: National health systems must promote patient-centered TB care, implement ethical community interventions, support operational research, and integrate appropriate eHealth applications. TB program managers and primary care practitioners can serve as instrumental leaders and patient advocates to deliver high-quality and sustainable TB care that leads to achieving the targets of the End TB Strategy.
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Affiliation(s)
- Helena J Chapman
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
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21
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Yadav P, Vohra C, Gopalakrishnan M, Garg MK. Integrating health planning and primary care infrastructure for COVID-19 and tuberculosis care in India: Challenges and opportunities. Int J Health Plann Manage 2021; 37:632-642. [PMID: 34820907 PMCID: PMC9015569 DOI: 10.1002/hpm.3393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/08/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis (TB) is the leading cause of death from a single infectious agent worldwide. The COVID‐19 pandemic has overburdened healthcare services around the world especially in resource constrained settings. It has shaken already unstable foundation of TB control programs in India and other high burden states. A 25% decline is expected in TB detection while estimates suggest 13% increase in TB deaths due to the impact of the pandemic. However, the significant intersections between the two diseases perhaps offer potential opportunities for consolidating the efforts to tackle both. The widespread implementation and acceptance of universal masking and social distancing in India has helped limit transmission of both diseases. Integrating the capacity building strategies for the two diseases, optimizing the existing the surveillance and monitoring systems which have been achieved over the years will result in a single vertically integrated national program addressing both, rather than multiple parallel program which utilize the already sparse primary care manpower and infrastructure. In this article, we explore the impact of the COVID‐19 pandemic on tuberculosis in India and offer suggestions on how effective health planning can efficiently integrate infrastructure and manpower at primary level to provide care for both COVID‐19 and tuberculosis. Tuberculosis deaths are on the rise for the first time in more than a decade due to the COVID‐19 pandemic. There is an urgent need to evolve an integrated service delivery addressing both diseases. This article highlights the challenges that COVID‐19 has posed for TB care in India. We propose a unified inclusive primary care delivery model which integrates care for both TB and COVID‐19 at the level of surveillance, diagnosis, management, and preventive care. The challenges in implementing this model and possible solutions are discussed.
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Affiliation(s)
- Prakrati Yadav
- Department of MedicineAll India Institute of Medical SciencesJodhpurIndia
| | - Chirag Vohra
- Department of MedicineAll India Institute of Medical SciencesJodhpurIndia
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22
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Garg R, Khurana AK, Khadanga S. The Monster Tuberculosis in India, Impending Epidemic in COVID-19 Era. J Lab Physicians 2021; 14:99-100. [PMID: 36186254 PMCID: PMC9519258 DOI: 10.1055/s-0041-1736479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Rahul Garg
- Section of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Alkesh Kumar Khurana
- Department of Pulmonary Medicine & TB, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Sagar Khadanga
- Section of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
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23
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Lipman M, McQuaid CF, Abubakar I, Khan M, Kranzer K, McHugh TD, Padmapriyadarsini C, Rangaka MX, Stoker N. The impact of COVID-19 on global tuberculosis control. Indian J Med Res 2021; 153:404-408. [PMID: 34380784 PMCID: PMC8354050 DOI: 10.4103/ijmr.ijmr_326_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Marc Lipman
- UCL Respiratory, Division of Medicine, Royal Free Campus University College London; Respiratory Medicine Royal Free London NHS Foundation Trust, UK
| | - C Finn McQuaid
- Department of Infectious Disease Epidemiology, TB Modelling Group, TB Centre & Centre for Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology & Population Health, UK
| | | | - Mishal Khan
- TB Centre & Faculty of Public Health & Policy, UK
| | - Katharina Kranzer
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, UK; Biomedical Research & Training Institute, Harare, Zimbabwe; Division of Infectious & Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - Timothy D McHugh
- Department of Medical Microbiology, Division of Infection & Immunity, University College London Centre for Clinical Microbiology, Royal Free Hospital Campus, UK
| | | | | | - Neil Stoker
- Department of Medical Microbiology, Division of Infection & Immunity, University College London Centre for Clinical Microbiology, Royal Free Hospital Campus, UK
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24
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Bhargava A, Bhargava M, Meher A. Universal health coverage and tuberculosis care in India in the times of Covid-19: Aligning Ayushman Bharat (National Health Assurance Scheme) to improve case detection, reduce deaths and catastrophic health expenditure. NATIONAL MEDICAL JOURNAL OF INDIA 2021; 33:298-301. [PMID: 34213460 DOI: 10.4103/0970-258x.303111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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.
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Affiliation(s)
- Anurag Bhargava
- Department of Medicine, Yenepoya Medical College, Centre for Nutrition Studies, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore 575018, Karnataka, India
| | - Madhavi Bhargava
- Department of Community Medicine, Yenepoya Medical College, Centre for Nutrition Studies, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore 575018, Karnataka, India
| | - Ajay Meher
- National Institute for Research in Tuberculosis, No. 1, Mayor Sathiyamoorthy Road, Chetput, Chennai 600031, Tamil Nadu, India
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25
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Hazra D, Chawla K, Shenoy VP, Pandey AK, S N. The aftermath of COVID-19 pandemic on the diagnosis of TB at a tertiary care hospital in India. J Infect Public Health 2021; 14:1095-1098. [PMID: 34274858 DOI: 10.1016/j.jiph.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/10/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The recent COVID-19 pandemic became a looming catastrophe over global public health and severely disrupted essential healthcare services like tuberculosis (TB). This study estimated the impact of the COVID-19 in the diagnosis of TB, a microbiology laboratory-based overview. METHOD This ambispective observational study was conducted at the Department of Microbiology in a tertiary care hospital in South Karnataka from January 2019 to December 2020. A standardized data collection sheet was prepared to collect the month-wise total number of suspected TB and confirmed TB samples. Data were analyzed using EZR 3.4.3 (R, open-source). Categorical variables were expressed in frequency and percentage. The Chi-square test was performed to test the difference in proportions and p < 0.05 indicated statistical significance. RESULTS In this study, a significant drop was observed in suspected TB specimens in 2020 compared to 2019, i.e. 54.8% for microscopy, along with 34.2% and 49.7% for Xpert MTB/RIF and MGIT culture respectively. Also, a sharp decline in confirmed TB samples was noted in 2020 with 49%, 43.8%, and 59.7% reduction with microscopy, Xpert MTB/RIF, and MGIT culture respectively, compared to 2019. Another major finding from this study reveals the PTB: EPTB proportion changed from 2.7:1 in 2019 to 2.1:1 in 2020, divulging an overall increase in EPTB sample proportion in 2020 (p = 0.0385). CONCLUSION The COVID-19 pandemic adversely impacted the TB diagnostic services, resulting in a significant reduction of active TB case detection. It highlights an urgent need to revise the strategies to control and eliminate TB in this hour of the pandemic crisis.
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Affiliation(s)
- Druti Hazra
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Kiran Chawla
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Vishnu P Shenoy
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Akhilesh K Pandey
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Nayana S
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
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26
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Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - S Matta
- New Delhi Tuberculosis Centre, New Delhi, India
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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27
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Ferrer JP, Suzuki S, Alvarez C, Berido C, Caballero M, Caraig B, Flores PI, Juson RJ, Lustresano A, Opinion T, Saavedra M, Verde A, Faguer BN, Cox SE, Solon JA. Experiences, challenges and looking to the future in a clinical tuberculosis cohort in the time of COVID-19 in the Philippines. Trans R Soc Trop Med Hyg 2021; 115:579-582. [PMID: 33693916 PMCID: PMC7989158 DOI: 10.1093/trstmh/trab025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/15/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022] Open
Abstract
A cohort study of Filipino tuberculosis patients is currently undergoing data collection amidst the coronavirus disease 2019 pandemic. In this article we present the current experiences, challenges and obstacles of our team during this period as we attempt to fulfil our roles and responsibilities in Metro Manila, Cebu and Negros Occidental in the Philippines. Each site had different lockdown restrictions and experienced problems to different degrees. The underlying themes were similar, covering the supply chain, mobility, communication, physical and mental health and disruption of health services due to reallocation of staff. While we maximized the use of mobile devices, logistical challenges remained. Institutional support for the field teams, creative problem solving and resilience are required to adapt in a rapidly changing environment.
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Affiliation(s)
- Julius Patrick Ferrer
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Shuichi Suzuki
- Nagasaki University Graduate School of Tropical Medicine and Global Health, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Cristelyn Alvarez
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Clarinda Berido
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Michelle Caballero
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Bliss Caraig
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Paul Ian Flores
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Romil Jeffrey Juson
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Ann Lustresano
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Trivon Opinion
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Michelle Saavedra
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Ares Verde
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Benjamin N Faguer
- Nagasaki University Graduate School of Tropical Medicine and Global Health, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Sharon E Cox
- Nagasaki University Graduate School of Tropical Medicine and Global Health, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.,Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.,Faculty of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Juan A Solon
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
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28
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Shewade HD, Nagaraja SB, Murthy HJD, Vanitha B, Bhargava M, Singarajipura A, Shastri SG, Reddy RC, Kumar AMV, Bhargava A. Screening People with Tuberculosis for High Risk of Severe Illness at Notification: Programmatic Experience from Karnataka, India. Trop Med Infect Dis 2021; 6:tropicalmed6020102. [PMID: 34203984 PMCID: PMC8293347 DOI: 10.3390/tropicalmed6020102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
Due to limited availability of diagnostics and capacity, people with tuberculosis do not always undergo systematic assessment for severe illness (requiring inpatient care). In Karnataka (south India), para-medical programme staff used a screening tool to identify people at 'high risk of severe illness', defined using indicators of very severe undernutrition, abnormal vital signs and poor performance status (any one): (i) body mass index (BMI) ≤ 14.0 kg/m2 (ii) BMI ≤ 16.0 kg/m2 with bilateral leg swelling (iii) respiratory rate > 24/min (iv) oxygen saturation < 94% (v) inability to stand without support. Of 3020 adults notified from public facilities (15 October to 30 November 2020) in 16 districts, 1531 (51%) were screened (district-wise range: 13-90%) and of them, 538 (35%) were classified as 'high risk of severe illness'. Short median delays in screening from notification (five days), and all five indicators being collected for 88% of patients, suggests the feasibility of using this tool in programme settings. However, districts with poor screening coverage require further attention. To end tuberculosis deaths, screening should be followed by referral to higher facilities for comprehensive clinical evaluation, to assess the need for inpatient care. Future studies should assess the validity (especially sensitivity in picking severely ill patients) of this screening tool.
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Affiliation(s)
- Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), 75006 Paris, France;
- The Union South-East Asia Office, New Delhi 110016, India
- Correspondence:
| | | | | | - Basavarajachar Vanitha
- Bowring and Lady Curzon Medical College and Research Institute, Bengaluru 560001, India;
| | - Madhavi Bhargava
- Centre for Nutrition Studies, Yenepoya (Deemed to be University), Mangaluru 575018, India; (M.B.); (A.B.)
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, India
| | - Anil Singarajipura
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru 560023, India; (A.S.); (S.G.S.); (R.C.R.)
| | - Suresh G. Shastri
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru 560023, India; (A.S.); (S.G.S.); (R.C.R.)
| | - Ramesh Chandra Reddy
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru 560023, India; (A.S.); (S.G.S.); (R.C.R.)
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), 75006 Paris, France;
- The Union South-East Asia Office, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, India
| | - Anurag Bhargava
- Centre for Nutrition Studies, Yenepoya (Deemed to be University), Mangaluru 575018, India; (M.B.); (A.B.)
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, India
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29
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McQuaid CF, Vassall A, Cohen T, Fiekert K, White RG. The impact of COVID-19 on TB: a review of the data. Int J Tuberc Lung Dis 2021; 25:436-446. [PMID: 34049605 PMCID: PMC8171247 DOI: 10.5588/ijtld.21.0148] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Abstract
Early in the COVID-19 pandemic, models predicted hundreds of thousands of additional TB deaths as a result of health service disruption. To date, empirical evidence on the effects of COVID-19 on TB outcomes has been limited. Here we summarise the evidence available at a country level, identifying broad mechanisms by which COVID-19 may modify TB burden and mitigation efforts. From the data, it is clear that there have been substantial disruptions to TB health services and an increase in vulnerability to TB. Evidence for changes in Mycobacterium tuberculosis transmission is limited, and it remains unclear how the resources required and available for the TB response have changed. To advocate for additional funding to mitigate the impact of COVID-19 on the global TB burden, and to efficiently allocate resources for the TB response, requires a significant improvement in the TB data available.
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Affiliation(s)
- C F McQuaid
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - A Vassall
- Department of Global Health Development, Faculty of Public Health and Policy, LSHTM, London, UK
| | - T Cohen
- Yale School of Public Health, Laboratory of Epidemiology and Public Health, New Haven, CT, USA
| | - K Fiekert
- KNCV Tuberculosefonds, The Hague, the Netherlands
| | - R G White
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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30
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Kargarpour Kamakoli M, Hadifar S, Khanipour S, Farmanfarmaei G, Fateh A, Mostafaei S, Siadat SD, Vaziri F. Tuberculosis under the Influence of COVID-19 Lockdowns: Lessons from Tehran, Iran. mSphere 2021; 6:e00076-21. [PMID: 33627506 PMCID: PMC8544884 DOI: 10.1128/msphere.00076-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This study investigates the short-term effects of the coronavirus disease 2019 (COVID-19) pandemic lockdown on tracing and detection of tuberculosis (TB) patients in Tehran, Iran. Results of this study have demonstrated that due to the significant decrease in the identification of patients with suspected TB during the COVID-19 outbreak in Tehran, it is imperative that patients with suspected TB be tracked and diagnosed more quickly to make up for some of the decline in TB diagnosis in recent months and to recover lost cases.
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Affiliation(s)
- Mansour Kargarpour Kamakoli
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Shima Hadifar
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Sharareh Khanipour
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Ghazaleh Farmanfarmaei
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Abolfazl Fateh
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Shayan Mostafaei
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah, Iran
- Epidemiology and Biostatistics Unit, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Davar Siadat
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Farzam Vaziri
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
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31
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Oga-Omenka C, Tseja-Akinrin A, Boffa J, Heitkamp P, Pai M, Zarowsky C. Commentary: Lessons from the COVID-19 global health response to inform TB case finding. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100487. [PMID: 33607520 PMCID: PMC7580683 DOI: 10.1016/j.hjdsi.2020.100487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has emerged as a serious threat to global public health, demanding urgent action and causing unprecedented worldwide change in a short space of time. This disease has devastated economies, infringed on individual freedoms, and taken an unprecedented toll on healthcare systems worldwide. As of 1 April 2020, over a million cases of COVID-19 have been reported in 204 countries and territories, resulting in more than 51,000 deaths. Yet, against the backdrop of the COVID-19 pandemic, lies an older, insidious disease with a much greater mortality. Tuberculosis (TB) is the leading cause of death by a single infectious agent and remains a potent threat to millions of people around the world. We discuss the differences between the two pandemics at present, consider the potential impact of COVID-19 on TB case management, and explore the opportunities that the COVID-19 response presents for advancing TB prevention and control now and in future.
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Affiliation(s)
- Charity Oga-Omenka
- École de Santé Publique de l'Université de Montréal (ESPUM), Canada; McGill International TB Center, Montreal, Canada; Centre de Recherche en Santé Publique, Université de Montréal (CReSP), Canada.
| | | | - Jody Boffa
- McGill International TB Center, Montreal, Canada; Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Petra Heitkamp
- McGill International TB Center, Montreal, Canada; TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Madhukar Pai
- McGill International TB Center, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Christina Zarowsky
- École de Santé Publique de l'Université de Montréal (ESPUM), Canada; Centre de Recherche en Santé Publique, Université de Montréal (CReSP), Canada; School of Public Health, University of the Western Cape, Bellville South Africa, South Africa
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Insight into the COVID-19 led slow-down in TB notifications in India. Indian J Tuberc 2021; 68:142-145. [PMID: 33641836 PMCID: PMC7745308 DOI: 10.1016/j.ijtb.2020.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022]
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Gupta M, Mohanta SS, Rao A, Parameswaran GG, Agarwal M, Arora M, Mazumder A, Lohiya A, Behera P, Bansal A, Kumar R, Meena VP, Tiwari P, Mohan A, Bhatnagar S. Transmission dynamics of the COVID-19 epidemic in India and modeling optimal lockdown exit strategies. Int J Infect Dis 2020; 103:579-589. [PMID: 33279653 PMCID: PMC7713576 DOI: 10.1016/j.ijid.2020.11.206] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 01/11/2023] Open
Abstract
India imposed one of the world’s strictest population-wide lockdowns on March 25, 2020 for COVID-19. We estimated epidemiological parameters, evaluated the effect of control measures on the epidemic in India, and explored strategies to exit lockdown. We obtained patient-level data to estimate the delay from onset to confirmation and the asymptomatic proportion. We estimated the basic and time-varying reproduction number (R0 and Rt) after adjusting for imported cases and delay to confirmation using incidence data from March 4 to April 25, 2020. Using a SEIR-QDPA model, we simulated lockdown relaxation scenarios and increased testing to evaluate lockdown exit strategies. R0 for India was estimated to be 2·08, and the Rt decreased from 1·67 on March 30 to 1·16 on April 22. We observed that the delay from the date of lockdown relaxation to the start of the second wave increases as lockdown is extended farther after the first wave peak—this delay is longer if lockdown is relaxed gradually. Aggressive measures such as lockdowns may be inherently enough to suppress an outbreak; however, other measures need to be scaled up as lockdowns are relaxed. Lower levels of social distancing when coupled with a testing ramp-up could achieve similar outbreak control as an aggressive social distancing regime where testing was not increased.
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Affiliation(s)
- Mohak Gupta
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Saptarshi Soham Mohanta
- Indian Institute of Science Education and Research (IISER), Dr Homi Bhabha Road, Pune, Maharashtra 411008, India
| | - Aditi Rao
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Giridara Gopal Parameswaran
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Mudit Agarwal
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Mehak Arora
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Archisman Mazumder
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Ayush Lohiya
- Super Specialty Cancer Institute & Hospital, Lucknow, Uttar Pradesh 226002, India
| | - Priyamadhaba Behera
- All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019, India
| | - Agam Bansal
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Rohit Kumar
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Ved Prakash Meena
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Pawan Tiwari
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Anant Mohan
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Sushma Bhatnagar
- All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India.
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Klinton JS, Oga-Omenka C, Heitkamp P. TB and COVID - Public and private health sectors adapt to a new reality. J Clin Tuberc Other Mycobact Dis 2020; 21:100199. [PMID: 33163631 PMCID: PMC7598345 DOI: 10.1016/j.jctube.2020.100199] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Health systems across the world have been baffled by the COVID19 pandemic. Tuberculosis (TB) care and prevention especially in high burden countries has faced disruption to their routine services. Though these setbacks were predicted by many modelling studies, reports and surveys from the field convey the hard reality faced by the TB services. However, health systems have not given up and have become resilient by adapting interesting strategies to overcome these obstacles. The private health sector has also stepped up to the occasion by supporting national TB programs through innovative approaches. The scientific community has laid down several evidence-based recommendations to help TB programs get back on track. Its time to unite these forces to not just overcome the challenge posed by the pandemic but also to build a more resilient health system.
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Affiliation(s)
- Joel Shyam Klinton
- McGill International TB Center, Montreal, Canada
- TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Charity Oga-Omenka
- McGill International TB Center, Montreal, Canada
- TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Petra Heitkamp
- McGill International TB Center, Montreal, Canada
- TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
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Kumar AM, Harries AD, Satyanarayana S, Thekkur P, Shewade HD, Zachariah R. What is operational research and how can national tuberculosis programmes in low- and middle-income countries use it to end TB? Indian J Tuberc 2020; 67:S23-S32. [PMID: 33308668 DOI: 10.1016/j.ijtb.2020.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022]
Abstract
Despite considerable progress over the years, tuberculosis (TB) still remains the top cause of death among the infectious diseases and has devastating socio-economic consequences for people in low- and middle-income countries. To add to this, the emergence of the COVID-19 pandemic has worsened delivery of TB care across the globe. As a global community, we have committed to end the TB epidemic by 2030. The World Health Organization has framed a strategy to achieve this goal which consists of three pillars namely i) integrated patient-centred care and prevention, ii) bold policies and systems and iii) intensified research and innovation. An analysis of the performance of national tuberculosis programmes (NTPs) across the globe against the ten priority indicators recommended for monitoring the end TB strategy show that there are huge gaps at every step in the cascade of care of TB patients. In our view, these gaps reflect suboptimal implementation of existing strategies known to be efficacious and operational research (OR) is one of the best available tools to plug the gaps. In this paper, we define what operational research is and how it differs from other kinds of research. We also share our views and experiences about how operational research can be used by NTPs to identify implementation gaps and their reasons, and develop and test possible solutions - which are then integrated to make changes to policy and practice and eventually improve programme outcomes. OR can be defined as research into interventions, strategies and tools which produces practical useable knowledge that can be used to enhance the quality, coverage, effectiveness and efficiency of disease control programmes, health services or health systems in which the research is conducted. The key steps in integrating operational research in the NTPs include: i) securing political commitment reflected by inclusion of OR in the national strategic plans of NTPs and earmarked funding, ii) having a critical mass of dedicated and trained human resources in OR within the NTP, iii) setting research priorities and steering the direction of research in the country, iv) using output-oriented models of capacity building such as the Structured Operational Research Training Initiative (SORT IT) model and building communities of practice, v) harnessing existing capacity in the country by forging partnerships with academia, vi) NTP-led nationwide, multicentre OR studies, vii) providing access to anonymized patient and programme surveillance data, vii) creating a forum for evidence dissemination and fostering policy change and ix) monitoring and accountability. In conclusion, ending the TB epidemic will not be possible without new tools (diagnostics, drugs, vaccines) and a multi-sectoral response involving stakeholders beyond the health ministry, including private providers, patients and communities. However, timely conduct of operational research to fine-tune programme implementation and ensuring proper deployment of new tools will be equally crucial to maximize the effectiveness and efficiency of interventions and ultimately contribute towards ending TB.
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Affiliation(s)
- Ajay Mv Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India; Yenepoya Medical College, Yenepoya (Deemed to Be University), Mangalore, India.
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; London School of Hygiene and Tropical Medicine, London, UK
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Hemant D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Geneva, Switzerland
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Kar SK, Menon V, Yasir Arafat SM, Kabir R. Research in Mental Health During the COVID-19 Pandemic: Quality versus quantity. Sultan Qaboos Univ Med J 2020; 20:e406-e407. [PMID: 33414953 PMCID: PMC7757926 DOI: 10.18295/squmj.2020.20.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sujita K. Kar
- Department of Psychiatry, King George’s Medical University, Lucknow India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - S. M. Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
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Shrinivasan R, Rane S, Pai M. India's syndemic of tuberculosis and COVID-19. BMJ Glob Health 2020; 5:e003979. [PMID: 33199280 PMCID: PMC7670552 DOI: 10.1136/bmjgh-2020-003979] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | - Madhukar Pai
- Department of Epidemiology and Biostatistics & McGill International TB Centre, McGill University, Montreal, Québec, Canada
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