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Kendall EA, Kitonsa PJ, Nalutaaya A, Robsky KO, Erisa KC, Mukiibi J, Cattamanchi A, Kato-Maeda M, Katamba A, Dowdy D. Decline in prevalence of tuberculosis following an intensive case finding campaign and the COVID-19 pandemic in an urban Ugandan community. Thorax 2024; 79:325-331. [PMID: 38050134 PMCID: PMC10947924 DOI: 10.1136/thorax-2023-220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Systematic screening is a potential tool for reducing the prevalence of tuberculosis (TB) and counteracting COVID-19-related disruptions in care. Repeated community-wide screening can also measure changes in the prevalence of TB over time. METHODS We conducted serial, cross-sectional TB case finding campaigns in one community in Kampala, Uganda, in 2019 and 2021. Both campaigns sought sputum for TB testing (Xpert MTB/RIF Ultra) from all adolescents and adults. We estimated the prevalence of TB among screening participants in each campaign and compared characteristics of people with TB across campaigns. We simultaneously enrolled and characterised community residents who were diagnosed with TB through routine care and assessed trends in facility-based diagnosis. RESULTS We successfully screened 12 033 community residents (35% of the estimated adult/adolescent population) in 2019 and 11 595 (33%) in 2021. In 2019, 0.94% (95% CI: 0.77% to 1.13%) of participants tested Xpert positive (including trace). This proportion fell to 0.52% (95% CI: 0.40% to 0.67%) in 2021; the prevalence ratio was 0.55 (95% CI: 0.40 to 0.75)). There was no change in the age (median 26 vs 26), sex (56% vs 59% female) or prevalence of chronic cough (49% vs 54%) among those testing positive. By contrast, the rate of routine facility-based diagnosis remained steady in the 8 months before each campaign (210 (95% CI: 155 to 279) vs 240 (95% CI: 181 to 312) per 100 000 per year). CONCLUSIONS Following an intensive initial case finding campaign in an urban Ugandan community in 2019, the burden of prevalent TB as measured by systematic screening had decreased by 45% in 2021, despite the intervening COVID-19 pandemic.
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Affiliation(s)
- Emily A Kendall
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter J Kitonsa
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Annet Nalutaaya
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
| | - Katherine O Robsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kamoga Caleb Erisa
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
| | - James Mukiibi
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
| | - Adithya Cattamanchi
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Orange, California, USA
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Midori Kato-Maeda
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Zhang Y, Zhang L, Gao W, Li M, Luo Q, Xiang Y, Bao K. The impact of COVID-19 pandemic on reported tuberculosis incidence and mortality in China: An interrupted time series analysis. J Glob Health 2023; 13:06043. [PMID: 37824176 PMCID: PMC10569365 DOI: 10.7189/jogh.13.06043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Background The reported number of cases and deaths from common infectious diseases can change during major public health crises. We explored whether the coronavirus disease 2019 (COVID-19) had an impact on tuberculosis (TB) incidence and mortality in China based on routinely reported TB data. Methods We used TB data used from the monthly national notifiable infectious disease reports in China from January 2015 to January 2023. Based on an interrupted time series (ITS) design, we applied Poisson and negative binomial regression models to assess the changes of reported TB incidence and mortality before and during the COVID-19 pandemic. Results We found a significant and immediate decrease in the levels of both reported TB incidence (relative risk (RR) = 0.887; 95% confidence interval (CI) = 0.810-0.973) and mortality (RR = 0.448; 95% CI = 0.351-0.572) at the start of COVID-19 outbreak. During the pandemic, the slope of reported incidence decreased significantly (RR = 0.994; 95% CI = 0.989-0.999), while the slope of reported mortality increased sharply (RR = 1.032; 95% CI = 1.022-1.041) owing to an abrupt rise in reported mortality after January 2022. Conclusions Both TB incidence and mortality decreased immediately at the start of the COVID-19 pandemic. Over a longer period, the COVID-19 pandemic had contributed to a sustained and more significant decrease in reported incidence, and a delayed but sharp increase in reported mortality.
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Affiliation(s)
- Yuqi Zhang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Li Zhang
- TB Prevention and Control Institute, Lanzhou Municipal Center for Disease Control and Prevention, Lanzhou, Gansu, China
| | - Wenlong Gao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ming Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Qiuxia Luo
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yuanyuan Xiang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Kai Bao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
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Dlangalala T, Musekiwa A, Mashamba-Thompson T. Impact of COVID-19 on TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa. Sci Rep 2023; 13:16645. [PMID: 37789034 PMCID: PMC10547754 DOI: 10.1038/s41598-023-43589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
We assessed the impact of the pandemic on TB diagnostics at primary healthcare clinics (PHCs) during the different stages of COVID-19 in eThekwini district, South Africa. Data from the District Health Information System (DHIS) were used to conduct an interrupted time series analysis that assessed the changes in TB investigations and confirmed TB cases during four pandemic periods: lockdown and the subsequent three peaks of infection compared to the two years prior (2018-2022). The initial lockdown resulted in - 45% (95% CI - 55 to - 31) and - 40% (95% CI - 59 to - 28) immediate declines in TB investigations and confirmed cases, respectively. Both indicators showed substantial recovery in the months after the first wave (p < 0.05). However, while TB investigations sustained smaller declines throughout the pandemic, they rebounded and surpassed pre-COVID-19 levels by the end of the investigation period. On the other hand, confirmed cases experienced reductions that persisted until the end of the investigation period. TB diagnostic services at PHCs were considerably disrupted by COVID-19, with the confirmation of cases being the most adversely affected throughout the pandemic. The reasons for these persistent declines in TB detection must be determined to inform the development of sustainable diagnostic systems that are capable of withstanding future pandemics.
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Affiliation(s)
- Thobeka Dlangalala
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, 0002, South Africa.
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, 0002, South Africa
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Andia-Biraro I, Baluku JB, Olum R, Bongomin F, Kyazze AP, Ninsiima S, Ssekamatte P, Kibirige D, Biraro S, Seremba E, Kabugo C. Effect of COVID-19 pandemic on inpatient service utilization and patient outcomes in Uganda. Sci Rep 2023; 13:9693. [PMID: 37322097 PMCID: PMC10272226 DOI: 10.1038/s41598-023-36877-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 06/12/2023] [Indexed: 06/17/2023] Open
Abstract
COVID-19 has had devastating effects on health systems but reports from sub-Saharan Africa are few. We compared inpatient admissions, diagnostic tests performed, clinical characteristics and inpatient mortality before and during the COVID-19 pandemic at an urban tertiary facility in Uganda. We conducted a retrospective chart review of patients admitted at Kiruddu National Referral Hospital in Uganda between January-July 2019 (before the pandemic) and January-July 2020 (during the pandemic). Of 3749 inpatients, 2014 (53.7%) were female, and 1582 (42.2%) had HIV. There was a 6.1% decline in admissions from 1932 in 2019 to 1817 in 2020. There were significantly fewer diagnostic tests performed in 2020 for malaria, tuberculosis, and diabetes. Overall, 649 (17.3%) patients died. Patients admitted during the COVID-19 pandemic (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.04-1.5, p = 0.018), patients aged ≥ 60 years (aOR 1.6, 95% CI 1.2-2.1, p = 0.001), HIV co-infected (aOR 1.5, 95% CI 1.2-1.9, p < 0.001), and those admitted as referrals (aOR 1.5, 95% CI 1.2-1.9, p < 0.001) had higher odds of dying. The COVID-19 pandemic disrupted inpatient service utilization and was associated with inpatient mortality. Policy makers need to build resilience in health systems in Africa to cope with future pandemics.
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Affiliation(s)
- Irene Andia-Biraro
- Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Joseph Baruch Baluku
- Kiruddu National Referral Hospital, Kampala, Uganda.
- Makerere University Lung Institute, PO Box 26343, Kampala, Uganda.
| | - Ronald Olum
- Department of Medicine, St Francis Hospital Nsambya, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Sandra Ninsiima
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Samuel Biraro
- Clockworks Research Company Limited, Kampala, Uganda
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Shete PB, Kadota JL, Nanyunja G, Namale C, Nalugwa T, Oyuku D, Turyahabwe S, Kiwanuka N, Cattamanchi A, Katamba A. Evaluating the impact of cash transfers on tuberculosis (ExaCT TB): a stepped wedge cluster randomised controlled trial. ERJ Open Res 2023; 9:00182-2023. [PMID: 37342088 PMCID: PMC10277874 DOI: 10.1183/23120541.00182-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 06/22/2023] Open
Abstract
Background Mitigating financial barriers to tuberculosis (TB) diagnosis and treatment is a core priority of the global TB agenda. We evaluated the impact of a cash transfer intervention on completion of TB testing and treatment initiation in Uganda. Methods We conducted a pragmatic complete stepped wedge randomised trial of a one-time unconditional cash transfer at 10 health centres between September 2019 and March 2020. People referred for sputum-based TB testing were enrolled to receive UGX 20 000 (∼USD 5.39) upon sputum submission. The primary outcome was the number initiating treatment for micro-bacteriologically confirmed TB within 2 weeks of initial evaluation. The primary analysis included cluster-level intent-to-treat and per-protocol analyses using negative binomial regression. Results 4288 people were eligible. The number diagnosed with TB initiating treatment was higher in the intervention period versus the pre-intervention period (adjusted rate ratio (aRR)=1.34) with a 95% CI of 0.62-2.91 (p=0.46), indicating a wide range of plausible true intervention effects. More were referred for TB testing (aRR=2.60, 95% CI 1.86-3.62; p<0.001) and completed TB testing (aRR=3.22, 95% CI 1.37-7.60; p=0.007) per National Guidelines. Results were similar but attenuated in per-protocol analyses. Surveys revealed that while the cash transfer supported testing completion, it was insufficient to address long-term underlying social/economic barriers. Interpretation While it is uncertain whether a single unconditional cash transfer increased the number of people diagnosed and treated for TB, it did support higher completion of diagnostic evaluation in a programmatic setting. A one-time cash transfer may offset some but not all of the social/economic barriers to improving TB diagnosis outcomes.
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Affiliation(s)
- Priya B. Shete
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jillian L. Kadota
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Grace Nanyunja
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Catherine Namale
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Talemwa Nalugwa
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Denis Oyuku
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | | | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Adithya Cattamanchi
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Kessel B, Heinsohn T, Ott JJ, Wolff J, Hassenstein MJ, Lange B. Impact of COVID-19 pandemic and anti-pandemic measures on tuberculosis, viral hepatitis, HIV/AIDS and malaria-A systematic review. PLOS Glob Public Health 2023; 3:e0001018. [PMID: 37126484 PMCID: PMC10150989 DOI: 10.1371/journal.pgph.0001018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/27/2023] [Indexed: 05/02/2023]
Abstract
COVID-19 pandemic puts an enormous strain on health care systems worldwide and may have a detrimental effect on prevention, treatment and outcomes of tuberculosis (TB), viral hepatitis, HIV/AIDS and malaria, whose ending is part of the United Nations 2030 Agenda for Sustainable Development. We conducted a systematic review of scientific and grey literature in order to collect wide-ranging evidence with emphasis on quantification of the projected and actual indirect impacts of COVID-19 on the four infectious diseases with a global focus. We followed PRISMA guidelines and the protocol registered for malaria (CRD42021234974). We searched PubMed, Scopus, preView (last search: January 13, 2021) and websites of main (medical) societies and leading NGOs related to each of the four considered infectious diseases. From modelling studies, we identified the most impactful disruptions; from surveys and other quantitative studies (based e.g. on surveillance or program data), we assessed the actual size of the disruptions. The identified modelling studies warned about under-diagnosis (TB), anti-retroviral therapy interruption/decrease in viral load suppression (HIV), disruptions of insecticide-treated nets (ITN) distribution and access to effective treatment (malaria), and treatment delays and vaccination interruptions (viral hepatitis). The reported disruptions were very heterogeneous both between and within countries. If observed at several points in time, the initial drops (partly dramatic, e.g. TB notifications/cases, or HIV testing volumes decreased up to -80%) were followed by a gradual recovery. However, the often-missing assessment of the changes against the usual pre-pandemic fluctuations hampered the interpretation of less severe ones. Given the recurring waves of the pandemic and the unknown mid- to long-term effects of adaptation and normalisation, the real consequences for the fight against leading infectious diseases will only manifest over the coming years.
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Affiliation(s)
- Barbora Kessel
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Torben Heinsohn
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Jördis J. Ott
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig, Germany
- Hannover Medical School (MHH), Hannover, Germany
| | - Jutta Wolff
- Hannover Medical School (MHH), Hannover, Germany
| | - Max J. Hassenstein
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig, Germany
- PhD Programme “Epidemiology”, Braunschweig, Hannover, Germany
| | - Berit Lange
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig, Germany
- German Center for Infection research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gemechu LL, Debusho LK. Spatial Co-Clustering of Tuberculosis and HIV in Ethiopia. Diseases 2022; 10. [PMID: 36412600 DOI: 10.3390/diseases10040106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Tuberculosis (TB) and HIV are epidemiologically associated, and their co-dynamics suggest that the two diseases are directly related at the population level and within the host. However, there is no or little information on the joint spatial patterns of the two diseases in Ethiopia. The main objective of the current study was to assess the spatial co-clustering of TB and HIV cases simultaneously in Ethiopia at the district level. Methods: District-level aggregated data collected from the national Health Management Information System (HMIS) for the years 2015 to 2018 on the number of TB cases enrolled in directly observed therapy, short course (DOTS) who were tested for HIV and the number of HIV patients enrolled in HIV care who were screened for TB during their last visit to health care facilities were used in this study. The univariate and bivariate global and local Moran’s I indices were applied to assess the spatial clustering of TB and HIV separately and jointly. Results: The results of this study show that the two diseases were significantly (p-value <0.001) spatially autocorrelated at the district level with minimum and maximum global Moran’s I values of 0.407 and 0.432 for TB, 0.102 and 0.247 for HIV, and 0.152 and 0.251 for joint TB/HIV. The district-level TB/HIV spatial co-clustering patterns in Ethiopia in most cases overlapped with the hot spots of TB and HIV. The TB/HIV hot-spot clusters may appear due to the observed high TB and HIV prevalence rates in the hot-spot districts. Our results also show that there were low-low TB/HIV co-clusters or cold spots in most of the Afar and Somali regions, which consistently appeared for the period 2015−2018. This may be due to very low notifications of both diseases in the regions. Conclusions: This study expanded knowledge about TB and HIV co-clustering in Ethiopia at the district level. The findings provide information to health policymakers in the country to plan geographically targeted and integrated interventions to jointly control TB and HIV.
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Lungu PS, Kerkhoff AD, Muyoyeta M, Kasapo CC, Nyangu S, Kagujje M, Chimzizi R, Nyimbili S, Khunga M, Kasese-Chanda N, Musonda V, Tambatamba B, Kombe CM, Sakulanda C, Sampa K, Silumesii A, Malama K. Interrupted time-series analysis of active case-finding for tuberculosis during the COVID-19 pandemic, Zambia. Bull World Health Organ 2022; 100:205-215. [PMID: 35261409 PMCID: PMC8886254 DOI: 10.2471/blt.21.286109] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/21/2021] [Accepted: 01/06/2022] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and the subsequent implementation of tuberculosis response measures on tuberculosis notifications in Zambia. Methods We used an interrupted time-series design to compare monthly tuberculosis notifications in Zambia before the pandemic (January 2019 to February 2020), after implementation of national pandemic mitigation measures (April 2020 to June 2020) and after response measures to improve tuberculosis detection (August 2020 to September 2021). The tuberculosis response included enhanced data surveillance, facility-based active case-finding and activities to generate demand for services. We used nationally aggregated, facility-level tuberculosis notification data for the analysis. Findings Pre-pandemic tuberculosis case notifications rose steadily from 2890 in January 2019 to 3337 in February 2020. After the start of the pandemic and mitigation measures, there was a −22% (95% confidence interval, CI: −24 to −19) immediate decline in notifications in April 2020. Larger immediate declines in notifications were seen among human immunodeficiency virus (HIV)-positive compared with HIV-negative individuals (−36%; 95% CI: −38 to −35; versus −12%; 95% CI: −17 to −6). Following roll-out of tuberculosis response measures in July 2020, notifications immediately increased by 45% (95% CI: 38 to 51) nationally and across all subgroups and provinces. The trend in notifications remained stable through September 2021, with similar numbers to the predicted number had the pandemic not occurred. Conclusion Implementation of a coordinated public health response including active tuberculosis case-finding was associated with reversal of the adverse impact of the pandemic and mitigation measures. The gains were sustained throughout subsequent waves of the pandemic.
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Affiliation(s)
- Patrick S Lungu
- National Tuberculosis and Leprosy Control Programme, Ministry of Health, Ndeke House, Haile-Selaise Road, PO Box 30205, Lusaka, Zambia
| | - Andrew D Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Clara C Kasapo
- National Tuberculosis and Leprosy Control Programme, Ministry of Health, Ndeke House, Haile-Selaise Road, PO Box 30205, Lusaka, Zambia
| | - Sarah Nyangu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Mary Kagujje
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Rhehab Chimzizi
- National Tuberculosis and Leprosy Control Programme, Ministry of Health, Ndeke House, Haile-Selaise Road, PO Box 30205, Lusaka, Zambia
| | - Sulani Nyimbili
- National Tuberculosis and Leprosy Control Programme, Ministry of Health, Ndeke House, Haile-Selaise Road, PO Box 30205, Lusaka, Zambia
| | - Morton Khunga
- National Tuberculosis and Leprosy Control Programme, Ministry of Health, Ndeke House, Haile-Selaise Road, PO Box 30205, Lusaka, Zambia
| | | | - Victoria Musonda
- Eradicate Tuberculosis Project, United States Agency for International Development, Lusaka, Zambia
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Arega B, Negesso A, Taye B, Weldeyohhans G, Bewket B, Negussie T, Teshome A, Endazenew G. Impact of COVID-19 pandemic on TB prevention and care in Addis Ababa, Ethiopia: a retrospective database study. BMJ Open 2022; 12:e053290. [PMID: 35135769 PMCID: PMC8829833 DOI: 10.1136/bmjopen-2021-053290] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The current COVID-19 pandemic in Ethiopia could cause severe dysfunction in tuberculosis (TB) treatment, diagnostic services, and prevention and control efforts. In this study, we evaluated the effect of COVID-19 on TB service indicators in Addis Ababa, where more than two-thirds of the country's COVID-19 morbidity was recorded. DESIGN We performed a comparative retrospective study to evaluate the impact of COVID-19 on TB services during the pre-COVID-19 era (from April 2019 to March 2020) and the COVID-19 era (from April 2020 to March 2021) in Addis Ababa, Ethiopia. We extracted data on total TB detection rate, TB treatment success rate, isoniazid prophylaxis therapy, and drug susceptibility tests and others from the health information system. Using Poisson regression, we estimated the incidence rate ratios and the absolute number difference of the indicators (number per quarter and year) in the COVID-19 and pre-COVID-19 eras. RESULTS Compared with the pre-COVID-19 era, the total TB detection, bacteriologically confirmed TB, TB treatment success rate, latent TB infection treatment and community health workers' engagement in TB detection decreased, respectively, by 11%, 11.8%, 17%, 44.7% and 77.2% during the COVID-19 period. Rifampicin resistance increased by 27.7% during the same period. Comparative analysis showed a significant decline in these TB service indicators (p<0.001) CONCLUSION: The COVID-19 pandemic has had a negative impact on TB service indicators in Addis Ababa. This highlights the importance of reinforcing TB services, including adopting alternative digital health technology to screen for TB and integrating TB and COVID-19 services to mitigate COVID-19's challenges to TB prevention and care.
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Affiliation(s)
- Balew Arega
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Abebe Negesso
- Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | - Betelhem Taye
- Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | | | - Bekure Bewket
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Ayele Teshome
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
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11
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Mohr-Holland E, Hacking D, Daniels J, Scott V, Mudaly V, Furin J, Pfaff C, Reuter A. Diagnosis patterns for rifampicin-resistant TB after onset of COVID-19. Int J Tuberc Lung Dis 2021; 25:772-775. [PMID: 34802503 PMCID: PMC8412107 DOI: 10.5588/ijtld.21.0340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/11/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- E Mohr-Holland
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa, MSF Southern Africa Medical Unit, Cape Town, South Africa
| | - D Hacking
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - J Daniels
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - V Scott
- City of Cape Town Department of Health, Eastern Area, Cape Town, South Africa
| | - V Mudaly
- Provincial Government of the Western Cape, Cape Town, South Africa
| | - J Furin
- Harvard Medical School, Boston, MA, USA
| | - C Pfaff
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - A Reuter
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
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12
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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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13
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Wang X, He W, Lei J, Liu G, Huang F, Zhao Y. Impact of COVID-19 Pandemic on Pre-Treatment Delays, Detection, and Clinical Characteristics of Tuberculosis Patients in Ningxia Hui Autonomous Region, China. Front Public Health 2021; 9:644536. [PMID: 34095053 PMCID: PMC8175850 DOI: 10.3389/fpubh.2021.644536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background: To contain the pandemic of COVID-19, China has implemented a series of public health interventions that impacted the tuberculosis control substantially, but these impacts may vary greatly depending on the severity of the local COVID-19 epidemic. The impact of COVID-19 on TB control in Ningxia Hui Autonomous Region is little known. Methods: Based on the national TB Information Management System (TBIMS), this study accessed the actual impact of COVID-19 on TB by comparing TB notifications, pre-treatment delays, and clinical characteristics of TB cases between 2020 COVID-19 period and 2017-2019 baseline. The data were divided into three periods based on the response started to fight against COVID-19 in Ningxia Hui Autonomous Region, including the control period (10 weeks before the pandemic), intensive period (10 weeks during the Ningxia Hui Autonomous Region lockdown), and regular (10 additional weeks after Ningxia Hui Autonomous Region reopen). Results: TB notification dropped sharply in the first week of the intensive period but took significantly longer to return to the previous level in 2020 compared with the 2017-2019 baseline. Totally, the TB notification rates decreased by more than 60% in the intensive period of COVID-19 compared with the average level of 2017-2019. The sputum smear-positive rate of TB patients diagnosed in intensive period of COVID-19 was significantly higher than that in the corresponding periods of 2017-2019 (P < 0.001). The rate of cavity on X-ray inspection of TB cases diagnosed in the intensive period of COVID-19 was significantly higher than that in period 2 of 2017-2019 (23.5 vs. 15.4%, P = 0.004). The patients' delay in the intensive period was significantly longer than that before the pandemic (P = 0.047). Conclusions: The TB notification in Ningxia was impacted dramatically by the pandemic of COVID-19. To compensate for the large numbers of missed diagnosis as well as delayed diagnosis during the intensive period of COVID-19, an urgent restoration of normal TB services, and further emphasis on enhanced active case finding and scale-up of household contact tracing and screening for TB-related symptoms or manifestation, will be essential.
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Affiliation(s)
- Xiaolin Wang
- The Fourth People's Hospital of Ning Xia Hui Autonomous Region, Yinchuan, China
| | - Wencong He
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Juan Lei
- The Fourth People's Hospital of Ning Xia Hui Autonomous Region, Yinchuan, China
| | - Guangtian Liu
- The Fourth People's Hospital of Ning Xia Hui Autonomous Region, Yinchuan, China
| | - Fei Huang
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanlin Zhao
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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14
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Silva DR, Mello FCDQ, D’Ambrosio L, Centis R, Dalcolmo MP, Migliori GB. Tuberculosis and COVID-19, the new cursed duet: what differs between Brazil and Europe? J Bras Pneumol 2021; 47:e20210044. [PMID: 33950095 PMCID: PMC8332832 DOI: 10.36416/1806-3756/e20210044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
On April 1st, 2020, COVID-19 surpassed tuberculosis regarding the number of deaths per day worldwide. The combination of tuberculosis and COVID-19 has great potential for morbidity and mortality. In addition, the COVID-19 pandemic has had a significant impact on the diagnosis and treatment of tuberculosis. In this review article, we address concurrent tuberculosis and COVID-19, with particular regard to the differences between Brazil and Europe. In addition, we discuss priorities in clinical care, public health, and research.
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Affiliation(s)
- Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | - Lia D’Ambrosio
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italia
| | - Rosella Centis
- . Blizard Institute, Queen Mary University of London, London, United Kingdom
| | | | - Giovanni Battista Migliori
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italia
- . Blizard Institute, Queen Mary University of London, London, United Kingdom
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15
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Duarte R, Aguiar A, Pinto M, Furtado I, Tiberi S, Lönnroth K, Migliori GB. Different disease, same challenges: Social determinants of tuberculosis and COVID-19. Pulmonology 2021; 27:338-344. [PMID: 33648891 PMCID: PMC7894090 DOI: 10.1016/j.pulmoe.2021.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/21/2022] Open
Abstract
Infectious diseases, such as tuberculosis (TB) and the novel coronavirus (COVID-19) relate to environmental factors, understanding of which is essential to inform policy and practice and tackle them effectively. The review follows the conceptual framework offered by the World Health Organization Commission on Social Determinants of Health (defined as “all those material, psychological and behavioural circumstances linked to health and generically indicated as risk factors’ in the conventional epidemiological language”). It describes the social factors behind TB and COVID-19, the commonalities between the two diseases, and what can be learned so far from the published best practices. The social determinants sustaining TB and COVID-19 underline the importance of prioritising health and allocating adequate financial and human resources to achieve universal health coverage and health-related social protection while addressing the needs of vulnerable populations. Rapid and effective measures against poverty and other major social determinants and sources of inequality are urgently needed to develop better health in the post-COVID-19 world.
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Affiliation(s)
- R Duarte
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal; Unidade de Investigação Clínica da Administração Regional de Saúde do Norte, Porto, Portugal; Departamento de Ciências de Saúde Pública, Ciências Forenses e Educação Médica, Universidade do Porto, Porto, Portugal; Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - A Aguiar
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - M Pinto
- Unidade de Investigação Clínica da Administração Regional de Saúde do Norte, Porto, Portugal; Faculdade de Psicologia e Ciências da Educação, Universidade do Porto, Porto, Portugal
| | - I Furtado
- Serviço de Infeciologia, Centro Hospitalar do Porto, Portugal
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Lönnroth
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
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16
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Visca D, Ong CWM, Tiberi S, Centis R, D'Ambrosio L, Chen B, Mueller J, Mueller P, Duarte R, Dalcolmo M, Sotgiu G, Migliori GB, Goletti D. Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects. Pulmonology 2021; 27:151-165. [PMID: 33547029 PMCID: PMC7825946 DOI: 10.1016/j.pulmoe.2020.12.012] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023] Open
Abstract
Evidence is accumulating on the interaction between tuberculosis (TB) and COVID-19. The aim of the present review is to report the available evidence on the interaction between these two infections. Differences and similarities of TB and COVID-19, their immunological features, diagnostics, epidemiological and clinical characteristics and public health implications are discussed. The key published documents and guidelines on the topic have been reviewed. Based on the immunological mechanism involved, a shared dysregulation of immune responses in COVID-19 and TB has been found, suggesting a dual risk posed by co-infection worsening COVID-19 severity and favouring TB disease progression. The available evidence on clinical aspects suggests that COVID-19 happens regardless of TB occurrence either before, during or after an active TB diagnosis. More evidence is required to determine if COVID-19 may reactivate or worsen active TB disease. The role of sequeale and the need for further rehabilitation must be further studied Similarly, the potential role of drugs prescribed during the initial phase to treat COVID-19 and their interaction with anti-TB drugs require caution. Regarding risk of morbidity and mortality, several risk scores for COVID-19 and independent risk factors for TB have been identified: including, among others, age, poverty, malnutrition and co-morbidities (HIV co-infection, diabetes, etc.). Additional evidence is expected to be provided by the ongoing global TB/COVID-19 study.
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Affiliation(s)
- D Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
| | - C W M Ong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute for Health Innovation & Technology (iHealthtech), National University of Singapore, Singapore
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - L D'Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - B Chen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - J Mueller
- The Mueller Health Foundation, Boston, MA, USA
| | - P Mueller
- The Mueller Health Foundation, Boston, MA, USA
| | - R Duarte
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Public Health Science and Medical Education Dept, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - M Dalcolmo
- Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
| | - D Goletti
- Translational Research Unit, Epidemiology and Preclinical Research Department, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
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17
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Dookie N, Padayatchi N, Naidoo K. Tuberculosis Elimination in the Era of COVID-19: A Moving Target. Clin Infect Dis 2020; 74:509-510. [PMID: 32927477 PMCID: PMC7543364 DOI: 10.1093/cid/ciaa1400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Navisha Dookie
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal Durban, South Africa.,South African Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal Durban, South Africa
| | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal Durban, South Africa.,South African Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal Durban, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal Durban, South Africa.,South African Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal Durban, South Africa
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