At-risk populations in 45 high-burden countries worldwide must be prioritized in efforts to reduce the impact of the COVID-19 pandemic on tuberculosis (TB) care, according to new research published in Medicine BMC.
Overall, there are as many as 195,449 children (under the age of 15), 1,126,133 adults (aged 15-64) and 235,402 seniors (aged 65 years). or more) are estimated to have had a missed or delayed diagnosis of tuberculosis in 2020 as a result of the COVID-19 disruptions. These figures include 511,546 women and 863,916 men.
The call to action follows the results of a new study looking at potential age and gender disparities in the impact of COVID-19 disruptions. pandemic on access to diagnoses of this deadly disease.
The team – which includes researchers from the London School of Hygiene and Tropical Medicine (LSHTM) – has modeled trends in the reporting of TB cases to the World Health Organization (WHO) for 45 high-burden countries between 2013 and 2019. Projections for 2020 were made using these models. Then compare the actual observations in the same year.
Although the study found no evidence of systematic variation in risk by age or sex on a global scale, when broken down by country, specific inequalities were revealed.
For example, in more than half of the countries (57.1%) analyzed, children were at greater risk of being diagnosed with delayed or missed tuberculosis due to COVID-19 than adults, with children in WHO regions in the Eastern Mediterranean ( namely Pakistan and Somalia) and Europe (eg Tajikistan and Ukraine) are disproportionately affected. Similarly, higher risk figures were detected for individuals who are older than for adults, i.e. in more than two thirds (70.1%), including WHO regions in the Western Pacific (eg China and Mongolia) and Europe (eg, Kazakhstan and Belarus ) . In nearly half of the countries (45%), gender was expected to be an influential risk factor. Men, for example, were found to be particularly vulnerable to missed or delayed diagnoses in the WHO region of the Americas (ie, Peru and Brazil).
These findings suggest that the epidemic may have left large numbers of people with TB untreated and unknowingly spread the infection, with long-term implications for public health.
Co-lead author Dr. Finn McQuaid, of the Center for Tuberculosis and the Center for Mathematical Modeling of Infectious Diseases (CMMID) at LSHTM, said: “Our results show that in many countries, those who already had the most difficulty obtaining a TB diagnosis and care experienced a deterioration in access as a result of the pandemic. As we look to rebuild and mitigate the impact of COVID-19 on people with TB, it is imperative that we focus on those most in need; and not only have a duty to address these inequalities, but have any hope of eradicating TB.” .
Despite being responsible for the second highest number of deaths from an infectious disease worldwide, tuberculosis case detection rates are low with unequal burden and access to care, particularly for men, the elderly, and children.
To date, investigations into tuberculosis care disruptions caused by COVID-19 have focused on the general impact of the epidemic, with little attention to the impact of potential disparities, such as those related to age or sex.
The results of this study may provide vital guidance regarding the key areas that policymakers should target to reduce the effects of the epidemic on the global TB burden, bringing us one step closer to ensuring equitable care for patients.
Co-author Dr. Kathryn Horton, also of the Center for Tuberculosis and CMMID, said, “Population groups whose access to a TB diagnosis has been disproportionately affected by the COVID-19 pandemic should be prioritized in catch-up campaigns. For example, in places where children have missed out. Diagnostics, and school-based strategies may be useful, while gender-sensitive strategies should be implemented in settings where one gender has been relatively underdiagnosed.”
She went on to highlight that “programs must also monitor the ongoing impact of the epidemic across these groups to ensure equitable access to TB care so that no one is left behind.”
Kathryn Horton et al, Inequality in the impact of COVID-19-related disorders on TB diagnosis by age and gender in 45 countries with a high TB burden, Medicine BMC (2022). DOI: 10.1186 / s12916-022-02624-6
London School of Hygiene and Tropical Medicine
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