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. 2022 Mar 30;2(3):e0000219.
doi: 10.1371/journal.pgph.0000219. eCollection 2022.

Impacts of COVID-19-related service disruptions on TB incidence and deaths in Indonesia, Kyrgyzstan, Malawi, Mozambique, and Peru: Implications for national TB responses

Rowan Martin-Hughes  1 , Lung Vu  2 , Nejma Cheikh  2 , Sherrie L Kelly  1 , Nicole Fraser-Hurt  2 , Zara Shubber  2 , Ivan Manhiça  3 , Kuzani Mbendera  4 , Belaineh Girma  4 , Imran Pambudi  5 , Julia Ríos  6 , Abdrahmanova Elmira  7 , Pandu Harimurti  2 , Reem Hafez  2 , Jaime Nicolas Bayona Garcia  2 , Tom Palmer  8 , Anna Roberts  1 , Marelize Gorgens  2 , David Wilson  2
Affiliations

Impacts of COVID-19-related service disruptions on TB incidence and deaths in Indonesia, Kyrgyzstan, Malawi, Mozambique, and Peru: Implications for national TB responses

Rowan Martin-Hughes et al. PLOS Glob Public Health. .

Abstract

Initial global-level estimates reported in June 2020 by the World Health Organization suggested that levels of disruption to TB service delivery could be as high as 25%-50% and result in an additional 6·3 million cases of tuberculosis (TB) and an additional 1·4 million TB-related deaths attributable to COVID-19 between 2020 and 2025. Quarterly epidemiological estimates and programmatic TB data capturing disruption levels to each TB service were collected by National TB Programmes in Indonesia, Kyrgyzstan, Malawi, Mozambique, and Peru. Data from 2019, for a pre-COVID-19 baseline, and throughout 2020, together with the NTP's COVID-19 response plans, were used within Optima TB models to project TB incidence and deaths over five years because of COVID-19-related disruptions, and the extent to which those impacts may be mitigated through proposed catch-up strategies in each country. Countries reported disruptions of up to 64% to demand-driven TB diagnosis. However, TB service availability disruptions were shorter and less severe, with TB treatment experiencing levels of disruption of up to 21%. We predicted that under the worse-case scenario cumulative new latent TB infections, new active TB infections, and TB-related deaths could increase by up to 23%, 11%, and 20%, respectively, by 2024. However, three of the five countries were on track to mitigate these increases to 3% or less by maintaining TB services in 2021 and 2022 and by implementing proposed catch-up strategies. Indonesia was already experiencing the worse-case scenario, which could lead to 270,000 additional active TB infections and 36,000 additional TB-related deaths by the end of 2024. The COVID-19 pandemic is projected to negatively affect progress towards 2035 End TB targets, especially in countries already off-track. Findings highlight both successful TB service delivery adaptions in 2020 and the need to proactively maintain TB service availability despite potential future waves of more transmissible COVID-19 variants.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Estimated daily COVID-19 infections for the study period reported by IHME based on reported COVID-19 daily cases, tests, and Google mobility data from 9 April 2021.
Fig 2
Fig 2. Impact of COVID-19-related disruptions to TB services on new latent TB infections, relative difference to the status quo counterfactual, 2018–2035.
Fig 3
Fig 3. Impact on new active pulmonary TB infections (excluding relapse), relative difference to the status quo counterfactual, 2018–2035.
Fig 4
Fig 4. Impact on TB-related deaths, relative difference to the status quo counterfactual, 2018–2035.
Fig 5
Fig 5. Impact of COVID-19-related disruptions to TB services on achieving the End TB milestones and targets, 2015 to 2035.
See this image and copyright information in PMC

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