Impact of the COVID-19 pandemic on TB services at ART programmes in low- and middle-income countries: a multi-cohort survey.

Autor: Marti M; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Zürcher K; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Enane LA; The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA., Diero L; Department of Medicine, Moi University School of Medicine, Eldoret, Kenya.; Department of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya., Marcy O; University of Bordeaux, Inserm U1219, IRD EMR271, Bordeaux, France., Tiendrebeogo T; University of Bordeaux, Inserm U1219, IRD EMR271, Bordeaux, France., Yotebieng M; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA., Twizere C; Centre National de Référence en matière de VIH/SIDA Burundi (CNR), Bujumbura, Burundi., Khusuwan S; Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand., Yunihastuti E; Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia., Reubenson G; Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Shah NS; Emory Rollins School of Public Health, Emory University, Atlanta, Georgia, USA., Egger M; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK., Ballif M; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Fenner L; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2022 Oct; Vol. 25 (10), pp. e26018.
DOI: 10.1002/jia2.26018
Abstrakt: Introduction: COVID-19 stretched healthcare systems to their limits, particularly in settings with a pre-existing high burden of infectious diseases, including HIV and tuberculosis (TB). We studied the impact of COVID-19 on TB services at antiretroviral therapy (ART) clinics in low- and middle-income countries.
Methods: We surveyed ART clinics providing TB services in the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in Africa and the Asia-Pacific until July 2021 (TB diagnoses until the end of 2021). We collected site-level data using standardized questionnaires.
Results: Of 46 participating ART clinics, 32 (70%) were in Africa and 14 (30%) in the Asia-Pacific; 52% provided tertiary care. Most clinics (85%) reported disrupted routine HIV care services during the pandemic, both in Africa (84%) and the Asia-Pacific (86%). The most frequently reported impacts were on staff (52%) and resource shortages (37%; protective clothing, face masks and disinfectants). Restrictions in TB health services were observed in 12 clinics (26%), mainly reduced access to TB diagnosis and postponed follow-up visits (6/12, 50% each), and restrictions in TB laboratory services (22%). Restrictions of TB services were addressed by dispensing TB drugs for longer periods than usual (7/12, 58%), providing telehealth services (3/12, 25%) and with changes in directly observed therapy (DOT) (e.g. virtual DOT, 3/12). The number of TB diagnoses at participating clinics decreased by 21% in 2020 compared to 2019; the decline was more pronounced in tertiary than primary/secondary clinics (24% vs. 12%) and in sites from the Asia-Pacific compared to Africa (46% vs. 14%). In 2021, TB diagnoses continued to decline in Africa (-8%) but not in the Asia-Pacific (+62%) compared to 2020. During the pandemic, new infection control measures were introduced or intensified at the clinics, including wearing face masks, hand sanitation and patient triage.
Conclusions: The COVID-19 pandemic led to staff shortages, reduced access to TB care and delays in follow-up visits for people with TB across IeDEA sites in Africa and the Asia-Pacific. Increased efforts are needed to restore and secure ongoing access to essential TB services in these contexts.
(© 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
Databáze: MEDLINE
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