Abstract
The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.
Highlights
The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria
We propose a checklist of essential criteria to consider: 1) Can TB Active case-finding (ACF) be conducted without diverting resources needed for the COVID-19 response? 2) Can it be conducted safely for staff and patients? 3) Is there government and stakeholder consensus on whether and how to proceed? 4) Will it be acceptable for individuals and communities?
We developed our framework of options for TB ACF adaptation by reviewing available literature on COVID-19, including international and Indonesian guidance on COVID-19 response
Summary
International Union Against Tuberculosis and Lung Disease Health solutions for the poor. Modelling shows that the pandemic and restrictions to manage it will negatively impact TB control by reducing TB detection and treatment, resulting in increased transmission and mortality.[7,8] In the first half of 2020, a 25– 30% reduction in TB notifications has already been observed in the four highest burden countries.[2] in a recent survey, 78% of Global Fund-supported TB programmes reported being disrupted by COVID-19.9. Passive case-finding (PCF) is vulnerable to disruption, as it usually relies on individuals to seek medical attention at health facilities after developing TB symptoms This is especially concerning because persons who are symptomatic are more likely to have severe disease, are at risk of poorer outcomes if undiagnosed, and are more likely to transmit TB to others.[5,10]. In Yogyakarta, we developed a framework to guide the adaptation of our programme’s activities so that TB ACF could be implemented during the COVID-19 pandemic
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