Facility-based directly observed therapy (DOT) for tuberculosis during COVID-19: A community perspective

Zimmer, A.; Heitkamp, Petra; Malar, James; Dantas, Cintia Santos; O’Brien, Kate; Pandita, Aakriti; Waite, Robyn C.

doi:10.1016/j.jctube.2021.100248

Cited by 26 publications

(46 citation statements)

References 25 publications

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“…67 Therefore, the appropriateness of rigid adherence support strategies, such as facility-based directly observed therapy (DOT), has come under increased scrutiny during the pandemic. 68 In many settings, facility-based DOT became impossible during COVID-19—patients could not access the health centre or were not allowed in, resulting in many people missing therapy. 68 To overcome the barriers created by facility-based DOT, there has been a shift towards strengthening community-based TB treatment services to ensure patients get the medicine in a timely fashion.…”

Section: Person-centric Healthcare Systemmentioning

confidence: 99%

“… 68 In many settings, facility-based DOT became impossible during COVID-19—patients could not access the health centre or were not allowed in, resulting in many people missing therapy. 68 To overcome the barriers created by facility-based DOT, there has been a shift towards strengthening community-based TB treatment services to ensure patients get the medicine in a timely fashion. 69 Other strategies include multimonth dispensing and home delivery of treatment.…”

Section: Person-centric Healthcare Systemmentioning

confidence: 99%

“… 69 Other strategies include multimonth dispensing and home delivery of treatment. 68 In the Philippines, the Department of Health issued a memorandum urging TB services to provide a 1-month supply of anti-TB medication instead of going to the facility for their daily dose. 70 This was issued after noting a near 10-fold decrease in patients receiving their treatment during the first quarter of 2020 compared with the same time period in 2019.…”

Section: Person-centric Healthcare Systemmentioning

confidence: 99%

“… 71 72 The increased acceptance and uptake of video DOT (vDOT) and other telemedicine options has helped overcome the barriers to non-medical support systems; however, this may only be an option in locations that have sufficient data/internet coverage. 68 Therefore, community-based care services must remain available in addition to vDOT strategies in order to provide more flexible treatment options during and beyond the COVID-19 pandemic.…”

Section: Person-centric Healthcare Systemmentioning

confidence: 99%

Section: Quality Of Care Including Safe and Effective Regimensmentioning

confidence: 99%

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Tuberculosis in times of COVID-19

Zimmer

Klinton

Oga‐Omenka

et al. 2021

J Epidemiol Community Health

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The COVID-19 pandemic has caused widespread disruptions to tuberculosis (TB) care and service delivery in 2020, setting back progress in the fight against TB by several years. As newer COVID-19 variants continue to devastate many low and middle-income countries in 2021, the extent of this setback is likely to increase. Despite these challenges, the TB community can draw on the comprehensive approaches used to manage COVID-19 to help restore progress and mitigate the impact of COVID-19 on TB. Our team developed the ‘Swiss Cheese Model for Ending TB’ to illustrate that it is only through multisectoral collaborations that address the personal, societal and health system layers of care that we will end TB. In this paper, we examine how COVID-19 has impacted the different layers of TB care presented in the model and explore how we can leverage some of the lessons and outcomes of the COVID-19 pandemic to strengthen the global TB response.

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Section: Person-centric Healthcare Systemmentioning

confidence: 99%

Section: Person-centric Healthcare Systemmentioning

confidence: 99%

Section: Person-centric Healthcare Systemmentioning

confidence: 99%

Section: Person-centric Healthcare Systemmentioning

confidence: 99%

Section: Quality Of Care Including Safe and Effective Regimensmentioning

confidence: 99%

See 3 more Smart Citations

Tuberculosis in times of COVID-19

Zimmer

Klinton

Oga‐Omenka

et al. 2021

J Epidemiol Community Health

Self Cite

View full text Add to dashboard Cite

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

Marti,

Zürcher,

Enane

et al. 2022

J Int AIDS Soc.

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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 sitelevel 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.

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