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We have seen how the world has come together to tackle the Covid-19 pandemic, but it is imperative to ensure that essential services and operations for dealing with the long-standing health problems such as TB continue, so as to protect the lives of people with TB and other diseases. Providers of essential health services, including national programmes to combat TB, need to be actively engaged to ensure an effective and rapid response to Covid-19, while ensuring that TB services are still maintained.
According to The World Health Organisation (WHO) in an Information Note released on 12 May 2020, modelling work suggests that if the Covid-19 pandemic led to a global reduction of 25% in expected TB detection for 3 months — a realistic possibility, given the levels of disruption in TB services being observed in multiple countries — then we can expect a 13% increase in TB deaths, bringing us back to the levels of TB mortality that we had five years ago. The WHO further estimates that between 2020 and 2025 an additional 1.4 million TB deaths could be registered as direct consequence of the Covid-19 pandemic.
Dr Patrick Lungu, TB Programme Manager in Zambia, elaborated on how Covid-19 in Zambia has negatively affected TB indicators. “Since the notification of the first two cases of Covid-19 in Zambia on March 18 2020, modification of service delivery was initiated in response to the outbreak,” says Lungu. “This resulted into a low turnout of patients in the outpatient department, resulting into reduced number of presumptive TB cases being identified; inadvertently, TB notifications plummeted,” he stated.
Below are the recommendations on how to maintain momentum in addressing tuberculosis during the Covid-19 pandemic in Africa:
Sustaining Screening and Diagnosis:
– Maintained access to services.
– Clear guidance to the general public about where and when to seek services.
– Education about the overlap in symptoms and presentation of Covid-19 and TB.
– Leverage expert for Covid-19 while maintaining TB services:
§ Extended operational hours
§ Deployment of additional staff
§ Monitoring and assignment of workload
§ Support specimen transportation.
– A shift from door-to-door campaigns to a targeted approach (mainly household contact tracing). Geospatial mapping of patients is helpful for this approach. |
Sustaining treatment:
– Orientation of healthcare workers in the adjustment in treatment modalities and provision of job aids.
– A shift from the weekly or monthly prescription, with an option of giving enough drugs for the entire intensive or continuation phase.
– Adjusting patient follow-ups to telephone calls.
– Strengthening the involvement of family members in the care of the patient.
– Psychosocial and nutritional support is of paramount importance.
Use of electronic platforms in response to TB in the era of Covid-19:
– Sustain capacity building, strategic meetings through electronic platforms such Zoom/Google Teams.
– Platforms such as electronic laboratory information systems for speedy transmission of results to both the patient and the care providers, and facilitate linkage to care.
– E- DOT to enhance treatment monitoring during total/partial lockdown. |
Re-orient delivery of drug-resistant TB (DR-TB) services amid Covid-19:
– Decentralized DR-TB services makes access easier to services.
– Transition of patients to an all-oral based regimen makes delivery of services easier.
– For patients on injectable based (Amikacin) regimen, community administration is ideal.
– Keep admission to the barest minimum; only patients warranting admission should be admitted.
Conduct monitoring and evaluation of the interventions:
– Develop an M&E framework that informs all levels of care and decision making.
– Establishing a response strategy to respond to the emerging issues is key.
– Creation of a situation room with all stakeholders involved.
– Participation of all stakeholders is critical.
– Following through about emerging issues brings motivation to all. |
Infection prevention and control:
– Provision of appropriate Personal Protective Equipment (PPE) for healthcare workers (HCWs) in all service points.
– Establish entry point in facilities and set up patient triage systems.
– All patients presenting to facilities to put on masks, observe physical distancing and hand hygiene.
– (handwashing/sanitising).
– Continued provision of TB Preventive Treatment (TPT) to people living with HIV (PLHIV) and contacts of TB patients.
– Align TPT to antiretroviral therapy (ART) clinic visits and contact tracing and adjusting to multiplemonth scripting.
– Decongest the health facilities by reducing the frequency of visitations. |
Lungu said that putting the patients, family and community needs at the centre is critical in sustaining the interventions. “Involvement of the patient in planning the care schedule is important to ensure success of the measures, while a steady supply chain is the heartbeat for sustaining TB service provision in the era of Covid-19,” he concluded.
Dr Saili Patrick Lungu is the National Tuberculosis and leprosy Programme Manager at the Ministry of Health Zambia. Zambia is one of four implementing countries of the Southern Africa Tuberculosis and Health System Support Project. The World Bank funded project was launched in 2016 with the aim of strengthening the health sector’s response to Tuberculosis and occupational lung diseases. It is implemented in four Southern African Development Community Member States: Lesotho, Malawi, Mozambique and Zambia. The African Union Development Agency and the East, Central and Southern Africa Health Community collaborate to provide technical support in project implementation in the participating countries. For more info: https://satbhss.org/