Impact of COVID-19 Pandemic on the National PPM Tuberculosis Control Project in Korea: the Korean PPM Monitoring Database between July 2019 and June 2020
Abstract:Background
The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to healthcare systems and endangered the control and prevention of tuberculosis (TB). We investigated the nationwide effects of COVID-19 on the national Public-Private Mix (PPM) TB control project in Korea, using monitoring indicators from the Korean PPM monitoring database.
Methods
The Korean PPM monitoring database includes data from patients registered at PPM hospitals throughout the count… Show more
“…For example, there are expected to be 6.3 million new cases and 1.4 million deaths caused by tuberculosis each year until 2025, setting the efforts to fight the world’s leading infectious disease killer further back [ 79 ]. Moreover, according to research in Korea, the treatment success rate decreased from 90.5% before COVID-19 to 84.6% after COVID-19, with a percentage change of −6.5% at the national level [ 80 ].…”
Section: Antibiotic Prescribing For Covid-19 and The Unnecessary Umentioning
The net effect of the coronavirus disease 2019 (COVID-19) pandemic and the response to it on the emergence of antimicrobial resistance is yet unknown. Positive impacts on the spread of multiresistant pathogens and infections in general may be observed with the implementation of general preventative measures for the spread of infectious disease such as social distancing, reduced travel and increased personal hygiene. This pandemic has accelerated the development of novel technologies, such as mRNA vaccines, that may be used to fight other diseases. These should be capitalized upon to manage the ongoing antimicrobial resistance pandemic in the background. However, it is likely that the COVID-19 pandemic is fueling the emergence of antimicrobial resistance due to high rates of inappropriate antimicrobial prescribing, the high use of biocides and the interruption of treatment for other conditions. Clinical uncertainty driven by the lack of effective diagnostics and practice of telemedicine may have driven the inappropriate use of antimicrobials. As pathogens know no borders, increased focus is needed for infectious diseases still threatening low- and middle-income countries such as tuberculosis. Stewardship measures for future outbreaks should stress the importance of social distancing and hand washing but discourage the overuse of disinfectants and antimicrobials that are not proven effective.
“…For example, there are expected to be 6.3 million new cases and 1.4 million deaths caused by tuberculosis each year until 2025, setting the efforts to fight the world’s leading infectious disease killer further back [ 79 ]. Moreover, according to research in Korea, the treatment success rate decreased from 90.5% before COVID-19 to 84.6% after COVID-19, with a percentage change of −6.5% at the national level [ 80 ].…”
Section: Antibiotic Prescribing For Covid-19 and The Unnecessary Umentioning
The net effect of the coronavirus disease 2019 (COVID-19) pandemic and the response to it on the emergence of antimicrobial resistance is yet unknown. Positive impacts on the spread of multiresistant pathogens and infections in general may be observed with the implementation of general preventative measures for the spread of infectious disease such as social distancing, reduced travel and increased personal hygiene. This pandemic has accelerated the development of novel technologies, such as mRNA vaccines, that may be used to fight other diseases. These should be capitalized upon to manage the ongoing antimicrobial resistance pandemic in the background. However, it is likely that the COVID-19 pandemic is fueling the emergence of antimicrobial resistance due to high rates of inappropriate antimicrobial prescribing, the high use of biocides and the interruption of treatment for other conditions. Clinical uncertainty driven by the lack of effective diagnostics and practice of telemedicine may have driven the inappropriate use of antimicrobials. As pathogens know no borders, increased focus is needed for infectious diseases still threatening low- and middle-income countries such as tuberculosis. Stewardship measures for future outbreaks should stress the importance of social distancing and hand washing but discourage the overuse of disinfectants and antimicrobials that are not proven effective.
“…For TB cases notified by PPM hospitals, the diagnosis of TB was delayed by 4 days compared to the previous 3 years, whereas it was not delayed for non-PPM hospitals and public health centers, which had fewer TB patients than before. Fortunately, the coverage of acid-fast bacilli smear and culture tests and drug susceptibility testing was above 90% at PPM hospitals, which implies that TB management was carried out at PPM hospitals under the national PPM TB control project in the ROK regardless of the pandemic [ 23 ].…”
Section: Discussionmentioning
confidence: 99%
“…A major reason for this may be the maintenance of dedicated TB nurses in PPM hospitals, even when medical resources were concentrated on the COVID-19 response [ 14 ]. In the analysis of TB management indicators at PPM medical institutions, it was reported that the initial TB test rate and the initial compliance rate with treatment guidelines during the COVID-19 pandemic were well maintained, without any substantial differences compared to the rates before COVID-19 [ 23 ]. In addition, it is necessary to consider the decrease in the number of people diagnosed with TB during the COVID-19 pandemic compared to the same period in 2017–2019 [ 11 ].…”
Objectives: We investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic on tuberculosis (TB) "diagnosis and" management in the Republic of Korea (ROK). Methods: This retrospective cross-sectional study used nationwide ROK TB notification data (98,346 cases) from 2017 to 2020. The median time from the onset of TB symptoms to treatment initiation and the compliance rates with the required timing for notification and individual case investigations were measured and compared across periods and regions affected by the COVID-19 epidemic. Results: TB diagnosis during the COVID-19 pandemic was delayed. The median time to TB treatment initiation (25 days) in 2020 increased by 3 days compared to that of the previous 3 years (22 days) (p < 0.0001). In the outbreak in Seoul, Incheon, and Gyeonggi province during August, the time to TB diagnosis was 4 days longer than in the previous 3 years (p = 0.0303). In the outbreak in Daegu and Gyeongbuk province from February to March 2020, the compliance rate with the required timing for individual case investigations was 2.2%p lower than in other areas in 2020 (p = 0.0148). For public health centers, the rate was 13%p lower than in other areas (80.3% vs. 93.3%, p = 0.0003). Conclusion: TB diagnoses during the COVID-19 pandemic in the ROK were delayed nationwide, especially for patients notified by public-private mix TB control hospitals. TB individual case investigations were delayed in regional COVID-19 outbreak areas (Daegu and Gyeongbuk province), especially in public health centers. Developing strategies to address this issue will be helpful for sustainable TB management during future outbreaks.
The COVID-19 pandemic has impacted health systems and health programs across the world. For tuberculosis (TB), it is predicted to set back progress by at least twelve years. Public private mix (PPM) is a collaborative approach to engage private providers in quality TB care. It has made a vital contribution to reach End TB targets with a ten-fold rise in TB notifications from private providers between 2012 and 2019. This is due in large part to the efforts of intermediary agencies, which aggregate demand from private providers. The COVID-19 pandemic has put these gains at risk over the past year. In this rapid assessment, representatives of 15 intermediary agencies from seven countries that are considered the highest priority for TB PPM (the Big Seven) share their views on the impact of COVID-19 on their programs, the private providers operating under their PPM schemes, and their private TB clients.
All intermediaries reported a drop in TB testing and notifications, and the closure of some private practices. While travel restrictions and the fear of contracting COVID were the main contributing factors, there were also unanticipated expenses for private providers, which were transferred to patients via increased prices. Intermediaries also had their routine activities disrupted and had to shift tasks and budgets to meet the new needs. However, the intermediaries and their partners rapidly adapted, including an increased use of digital tools, patient-centric services, and ancillary support for private providers.
Despite many setbacks, the COVID-19 pandemic has underlined the importance of effective private sector engagement. The robust approach to fight COVID-19 has shown the possibilities for ending TB with a similar approach, augmented by the digital revolution around treatment and diagnostics and the push to decentralize health services.
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