Target COVID-19 catch-up interventions for TB at vulnerable groups, scientists advise

According to a new study published in BMC Medicine.

Overall, it is estimated that as many as 195,449 children (aged under 15), 1,126,133 adults (aged 15-64) and 235,402 elderly (aged 65 or over) had a missed or delayed diagnosis of tuberculosis in 2020 as a result of disruptions related to COVID-19. These figures include 511,546 women and 863,916 men.

The call to action follows findings from a new study looking at potential age and gender inequities of the impact of disruptions caused by the COVID-19 pandemic on access to diagnostics for this fatal illness.

The team, including researchers from the London School of Hygiene & Tropical Medicine (LSHTM), modeled trends in TB case reporting to the World Health Organization (WHO) for 45 high-burden countries between 2013 and 2019. Predictions for 2020 using these models were then compared to actual observations for the same year.

Although the study found no evidence of systemic disparity in risk by age or sex globally, when disaggregated by country, context-specific inequalities were revealed.

For example, in more than half of the countries (57.1%) analyzed, children were at greater risk of having their TB diagnosis delayed or missed due to COVID-19 than adults, children in WHO regions from the Eastern Mediterranean (i.e. Pakistan and Somalia) and Europe (e.g. Tajikistan and Ukraine) were found to be disproportionately affected. Similarly, higher risk figures for older people compared to adults were also revealed, namely in more than two-thirds of countries (70.1%), including the WHO regions in the Western Pacific. (such as China and Mongolia) and Europe (eg Kazakhstan and Belarus) . In almost half of the countries (45%), gender was considered an influential risk factor. Men, for example, were found to be particularly susceptible to missed or delayed diagnoses in the WHO Region of the Americas (namely Peru and Brazil).

These findings suggest that the pandemic may have resulted in large numbers of people with TB going untreated and unknowingly spreading the infection, with long-term public health ramifications.

Joint lead author Dr Finn McQuaid, from the Tuberculosis Center and the Center for Mathematical Modeling of Infectious Diseases (CMMID) at LSHTM, said: “Our results show that in many countries those who have already encountered the more difficulty getting TB diagnosis and care have As we seek to rebuild and mitigate the impact that COVID-19 has had on people with TB, it is critical that we focus on those who need it the most, and not just out of a duty to address these inequities, but to have any hope of ending TB.”

Despite being responsible for the second highest number of deaths from an infectious disease in the world, TB case detection rates are low with inequalities in burden and access to care, particularly for men, women and men. old people and children.

So far, investigations of the disruptions in TB patient care caused by COVID-19 have focused on the overall impact of the pandemic, disregarding the effect of potential inequities, such as those related to the age or sex.

The results of this study can provide critical insights into key areas that should be targeted by policy makers to reduce the impacts of the pandemic on the global TB burden, bringing us one step closer to ensuring equitable patient care. .

Co-author Dr Katherine Horton, also of the TB Center and CMMID, said: “Population groups whose access to TB diagnosis has been disproportionately affected by the COVID-19 pandemic should be priorities in catch-up campaigns. For example, in settings where children have missed diagnoses, school-based strategies may be helpful, while gender-sensitive strategies should be implemented in settings where one gender has been relatively underdiagnosed. “

She went on to stress that “programs must also monitor the continued impact of the pandemic on these groups to ensure equitable access to TB care so that no one is left behind.”