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

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.

The impact of the COVID-19 pandemic on patients’ experiences obtaining a tuberculosis diagnosis in Peru: a mixed-methods study

“…Our finding that the initial phase of the COVID-19 pandemic was associated with longer delays in TB diagnosis is consistent with reports from other countries that showed that patients experienced longer overall delays during the pandemic compared to before [2][3][4][5]. In most studies that distinguished between delay before and after contact with the health system, the former was far longer than the latter; in these studies, the average delay after entering the health system was generally under a week, even during the pandemic, and overall delay was driven by the delay in accessing health services [2,3,5].…”

“…The global COVID-19 pandemic overwhelmed and disrupted health services worldwide, negatively impacting the delivery of TB services in many countries. Globally, there were 18% fewer TB cases diagnosed in 2020 compared to 2019 [1], and reports from diverse countries have measured significantly longer delays in TB diagnosis during the pandemic [2][3][4][5]. Modeling studies suggest that the pandemic has caused substantial increases in TB-associated mortality by delaying TB diagnoses or causing diagnoses to be missed completely [6,7].…”

The COVID-19 impact on tuberculosis incidence notification in India- A comparative study (2017-2022)

“…People were terri ed of getting COVID-19, which had a signi cant impact on TB control. It was challenging for people to get to care facilities due to the transportation constraints [47]. In order to combat COVID-19, TB laboratories and TB wards were reassigned, which also disrupted TB services due to delayed diagnosis and treatment beginning.…”

Impact of COVID-19 on the cascade of care for tuberculosis: A systematic review

“…The study designs of the included studies were as follows; one study was described as a surveillance report [45], 12 studies were longitudinal before and after time series [15,24,[30][31][32][34][35][36][37][38][39][40], 12 were cohort studies [17,[20][21][22][27][28][29]33,[41][42][43] and the remaining three were cross-sectional studies [23,25,44]. Ten studies [17,25,26,29,31,32,34,36,37,39] had nationally representative data while others were provincial, and community based.…”

“…Ten studies [17,25,26,29,31,32,34,36,37,39] had nationally representative data while others were provincial, and community based. About six studies reported some summary measures of age [30,[33][34][35]38,40], but the other twenty-one studies did not state the age of included participants. The characteristics of the included studies are shown in Supplementary Table 1.…”