Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe.

Pruthu Thekkur,Srinath Satyanarayana,I D Rusen,Selma Dar Berger,Mohammed Khogali,Charles Sandy,Kudakwashe C Takarinda,Rony Zachariah,Hemant D Shewade,Anthony D Harries,Tsitsi Apollo,Collins Timire,Ajay M V Kumar

doi:10.3390/tropicalmed6020094

Abstract

When COVID-19 was declared a pandemic, there was concern that TB and HIV services in Zimbabwe would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in 10 health facilities in Harare to capture trends in TB case detection, TB treatment outcomes and HIV testing and use these data to facilitate corrective action. Aggregate data were collected monthly during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data extracted for the pre-COVID-19 period (March 2019–February 2020). Monthly reports were sent to program directors. During the COVID-19 period, there was a decrease in persons with presumptive pulmonary TB (40.6%), in patients registered for TB treatment (33.7%) and in individuals tested for HIV (62.8%). The HIV testing decline improved in the second 6 months of the COVID-19 period. However, TB case finding deteriorated further, associated with expiry of diagnostic reagents. During the COVID-19 period, TB treatment success decreased from 80.9 to 69.3%, and referral of HIV-positive persons to antiretroviral therapy decreased from 95.7 to 91.7%. Declining trends in TB and HIV case detection and TB treatment outcomes were not fully redressed despite real-time monthly surveillance. More support is needed to transform this useful information into action.

Highlights

In early January 2020, a new coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was linked to a series of atypical pneumonia cases reported the previous month in Wuhan city, Hubei province, China
This study suggested that better contact tracing of TB patients and heightened attention to reducing the “not evaluated” category were important interventions for TB case detection and TB treatment outcomes
Using strengthened monthly real-time surveillance in 10 health facilities in Harare, Zimbabwe, we documented that numbers of persons with presumptive pulmonary TB (PTB) and registered

Summary

Introduction

In early January 2020, a new coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was linked to a series of atypical pneumonia cases reported the previous month in Wuhan city, Hubei province, China. The virus spread rapidly within China, and onto Europe, the United States of America (USA) and the rest of the world, causing the disease known as COVID-19. In. April 2020, one month after the pandemic had been declared, the epicenters were China, Europe and the USA, and with large volumes of air traffic between these regions and Africa, sub-Saharan Africa was predicted to be the region to be hard hit by COVID-19 [2,3]. National and local lockdowns restricted movement and forced people to spend more time indoors, limiting access to health facilities. All of this raised concern that countries with high burdens of tuberculosis (TB) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) might see interruption of health services and poor quality of care for their patients [4]. Modeling studies suggested that deaths due to HIV/AIDS and TB could increase by up to 10 and 20%, respectively, with the greatest impact on HIV resulting from interruption to antiretroviral therapy (ART) and the greatest impact on TB resulting from delayed diagnosis and treatment of new cases [5]

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