Influence of Ebola on tuberculosis case finding and treatment outcomes in Liberia

Abstract

National Leprosy and Tuberculosis (TB) Control Programme, Liberia. To assess TB case finding, including human immunodeficiency virus (HIV) associated interventions and treatment outcomes, before (January 2013-March 2014), during (April 2014-June 2015) and after (July-December 2015) the Ebola virus disease outbreak. A cross-sectional study and retrospective cohort analysis of outcomes. The mean quarterly numbers of individuals with presumptive TB and the proportion diagnosed as smear-positive were: pre-Ebola ( = 7032, 12%), Ebola ( = 6147, 10%) and post-Ebola ( = 6795, 8%). For all forms of TB, stratified by category and age group, there was a non-significant decrease in the number of cases from the pre-Ebola to the Ebola and post-Ebola periods. There were significant decreases in numbers of cases with smear-positive pulmonary TB (PTB) from the pre-Ebola period ( = 855), to the Ebola ( = 640, < 0.001) and post-Ebola ( = 568, < 0.001) periods. The proportions of patients tested for HIV, found to be HIV-positive and started on antiretroviral therapy decreased as follows: pre-Ebola (respectively 72%, 15% and 34%), Ebola (69%, 14% and 30%) and post-Ebola (68%, 12% and 26%). Treatment success rates among TB patients were: 80% pre-Ebola, 69% Ebola ( < 0.001) and 73% post-Ebola ( < 0.001). Loss to follow-up was the main contributing adverse outcome. The principal negative effects of Ebola were the significant decreases in diagnoses of smear-positive PTB, the declines in HIV testing and antiretroviral therapy uptake and poor treatment success. Ways to prevent these adverse effects from recurring in the event of another Ebola outbreak need to be found.

Impact of the Ebola virus disease outbreak (2014–2016) on tuberculosis surveillance activities by Guinea’s National Tuberculosis Control Program: a time series analysis

“…Despite the negative impact of the EVD epidemic on the diagnosis and reporting of tuberculosis cases, the therapeutic success rate remained stable above 80%, with a slight increase after the epidemic. This confirms that diagnosed TB cases were properly managed during the EVD outbreak in Guinea, as attested by several other studies [ 16 , 19 , 21 ], including one in Guinea [ 18 ], which registered a higher success rate during the EVD outbreak.…”

The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016

“…These findings suggest the need for the development of best practices, coordinated responses, and larger global investments in public-sector health system strengthening efforts when responding to future global public health emergencies [ 34 ]. The emerging evidence from Sierra Leone [ 2 , 16 , 17 , 22 ], Guinea [ 3 , 4 , 11 , 15 ], and Liberia ([ 6 – 10 ] and our study) suggests that, in terms of morbidity and mortality, the collateral effects from the EVD outbreak on public-sector primary healthcare delivery will greatly exceed the direct effects from EVD infection. Analyses using population-based surveys in Liberia suggest that distrust of the government and the health system was the primary source of reduced health service demand during the EVD outbreak, rather than supply-side factors [ 29 ].…”

“…Analyses using routine health information system (RHIS) data originating from Guinea and Sierra Leone have recently chronicled the effect of the EVD epidemic on the delivery of public-sector care for maternal, child, and reproductive health services, showing dramatic decreases during the Ebola outbreak (on the order of 50% declines) and sustained low levels not suggesting recovery [ 3 – 5 ]. Previous descriptive studies using RHIS data from Liberia have shown decreases in maternal and child health (MCH) indicators [ 6 , 7 ], malaria treatment [ 8 ], HIV testing [ 9 ], and tuberculosis diagnoses [ 10 ] during the EVD outbreak. Others have estimated that EVD-related disruptions in treating malaria alone will contribute to significantly more excess deaths than direct EVD-related mortality [ 11 ].…”

COVID-19 in humanitarian settings and lessons learned from past epidemics

“…People with chronic conditions, including HIV, tuberculosis, cardiovascular disease and diabetes, require continuity of care and are at increased risk of death or complications if their treatment is interrupted 4,5 . They are also more susceptible to severe and fatal COVID-19 infection.…”