The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa
Background The COVID-19 pandemic challenged healthcare systems, particularly in settings with high infectious disease burden. We examined the postpandemic long-term impacts of COVID-19 on tuberculosis (TB) services at anti-retroviral therapy (ART) clinics in lower-income countries.Methods Using stan...
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BMJ Publishing Group
2025-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/3/e017828.full |
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| author | Marcel Yotebieng Lukas Fenner Haruka Uemura Jacqueline Huwa Ellen Brazier Marie Ballif Oliver Ezechi Anchalee Avihingsanon Denna Michael Jonathan Euvrard Guy Muula Nagalingeswaran Kumarasamy Lameck Diero Brian Otaalo Eric Komena Nicolas Banholzer Lisa Perrig Dominique Mahambu Nsonde Sarah Obatsa Patricia Lelo Patrice Gouéssé Idiovino Rafael Richard Ramdé I Ketut Agus Somia |
| author_facet | Marcel Yotebieng Lukas Fenner Haruka Uemura Jacqueline Huwa Ellen Brazier Marie Ballif Oliver Ezechi Anchalee Avihingsanon Denna Michael Jonathan Euvrard Guy Muula Nagalingeswaran Kumarasamy Lameck Diero Brian Otaalo Eric Komena Nicolas Banholzer Lisa Perrig Dominique Mahambu Nsonde Sarah Obatsa Patricia Lelo Patrice Gouéssé Idiovino Rafael Richard Ramdé I Ketut Agus Somia |
| author_sort | Marcel Yotebieng |
| collection | DOAJ |
| description | Background The COVID-19 pandemic challenged healthcare systems, particularly in settings with high infectious disease burden. We examined the postpandemic long-term impacts of COVID-19 on tuberculosis (TB) services at anti-retroviral therapy (ART) clinics in lower-income countries.Methods Using standardised online questionnaires, we conducted a cross-sectional site survey among ART clinics providing TB services in Africa and Asia from July to September 2023 (site-level information and number of TB diagnoses and tests).Results Of 45 participating ART clinics, 32 (71%) were in Africa and 13 (29%) in Asia. During the COVID-19 pandemic (2020–2022), 43 (96%) clinics reported implementing social distancing or separation measures, 39 (87%) personal protections for staff members and 32 (71%) protections for patients. Infection control measures were in place in 45% of the clinics before the pandemic (until 2019), 23% introduced measures during the pandemic and 15% maintained them after the pandemic (after 2022). Service provision was affected during the pandemic in 33 (73%) clinics, including TB services in 22 (49%) clinics. TB service restrictions were addressed by introducing changes in directly observed therapy provision in 8 (18%) clinics, multimonth TB drug dispensing in 23 (51%), telehealth services in 25 (56%) and differentiated service delivery in 19 (42%). These changes were sustained after the pandemic at 4 (9%), 11 (24%), 17 (38%) and 12 (27%) clinics, respectively. Compared with 2018–2019, the number of TB diagnoses decreased sharply in 2020–2021 and improved after the pandemic.Conclusions COVID-19 affected TB care services in ART clinics in Africa and Asia. This was paralleled by a reduction in TB diagnoses, which partly resumed after the pandemic. Infection control measures and alternative modes of service delivery were adopted during the pandemic and only partially maintained. Efforts should be made to sustain the lessons learnt during the COVID-19 pandemic, particularly approaches that reduce the risk of transmission of infectious diseases, including TB, in ART clinics. |
| format | Article |
| id | doaj-art-85c834d6e3114bb2aac913d10a1fc4ac |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-03-01 |
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| spelling | doaj-art-85c834d6e3114bb2aac913d10a1fc4ac2025-08-20T01:50:13ZengBMJ Publishing GroupBMJ Global Health2059-79082025-03-0110310.1136/bmjgh-2024-017828The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and AfricaMarcel Yotebieng0Lukas Fenner1Haruka Uemura2Jacqueline Huwa3Ellen Brazier4Marie Ballif5Oliver Ezechi6Anchalee Avihingsanon7Denna Michael8Jonathan Euvrard9Guy Muula10Nagalingeswaran Kumarasamy11Lameck Diero12Brian Otaalo13Eric Komena14Nicolas Banholzer15Lisa Perrig16Dominique Mahambu Nsonde17Sarah Obatsa18Patricia Lelo19Patrice Gouéssé20Idiovino Rafael21Richard Ramdé22I Ketut Agus Somia23Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USAInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandAIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, JapanLighthouse Trust, Lilongwe, MalawiCity University of New York, Institute for Implementation Science in Population Health, New York, NY, USAInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandCentre for Reproduction and Population Health Studies, Nigerian Institute of Medical Research, Lagos, NigeriaHIV-NAT / Thai Red Cross AIDS Research Centre and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandKisesa Observation Cohort study, National Institute for Medical Reseach, Mwanza, TanzaniaSchool of Public Health, University of Cape Town, Cape Town, South AfricaCentre for Infectious Disease Research in Zambia, Lusaka, ZambiaCART Clinical Research Site, Voluntary Health Services, Chennai, IndiaDepartment of Medicine, Moi University, AMPATH Program / Moi Teaching and Referral Hospital, Eldoret, KenyaInfectious Diseases Institute, Makerere University College of Health Sciences, Kampala, UgandaPAC-CI program, Abidjan, Côte d’IvoireInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandCentre de Traitement Ambulatoire, Brazzaville, Republic of CongoCentre for Microbiology and Research, Kenya Medical Research Institute, Kisumu, KenyaPediatric Hospital of Kalembelembe, Kinshasa, Democratic Republic of the CongoCePReF, Abidjan, Côte d’IvoireSolidarMed, Chiure, MozambiqueCHU Sourô Sanou, Bobo-Dioulasso, Burkina FasoFaculty of Medicine, Udayana University, Ngoerah Hospital, Bali, IndonesiaBackground The COVID-19 pandemic challenged healthcare systems, particularly in settings with high infectious disease burden. We examined the postpandemic long-term impacts of COVID-19 on tuberculosis (TB) services at anti-retroviral therapy (ART) clinics in lower-income countries.Methods Using standardised online questionnaires, we conducted a cross-sectional site survey among ART clinics providing TB services in Africa and Asia from July to September 2023 (site-level information and number of TB diagnoses and tests).Results Of 45 participating ART clinics, 32 (71%) were in Africa and 13 (29%) in Asia. During the COVID-19 pandemic (2020–2022), 43 (96%) clinics reported implementing social distancing or separation measures, 39 (87%) personal protections for staff members and 32 (71%) protections for patients. Infection control measures were in place in 45% of the clinics before the pandemic (until 2019), 23% introduced measures during the pandemic and 15% maintained them after the pandemic (after 2022). Service provision was affected during the pandemic in 33 (73%) clinics, including TB services in 22 (49%) clinics. TB service restrictions were addressed by introducing changes in directly observed therapy provision in 8 (18%) clinics, multimonth TB drug dispensing in 23 (51%), telehealth services in 25 (56%) and differentiated service delivery in 19 (42%). These changes were sustained after the pandemic at 4 (9%), 11 (24%), 17 (38%) and 12 (27%) clinics, respectively. Compared with 2018–2019, the number of TB diagnoses decreased sharply in 2020–2021 and improved after the pandemic.Conclusions COVID-19 affected TB care services in ART clinics in Africa and Asia. This was paralleled by a reduction in TB diagnoses, which partly resumed after the pandemic. Infection control measures and alternative modes of service delivery were adopted during the pandemic and only partially maintained. Efforts should be made to sustain the lessons learnt during the COVID-19 pandemic, particularly approaches that reduce the risk of transmission of infectious diseases, including TB, in ART clinics.https://gh.bmj.com/content/10/3/e017828.full |
| spellingShingle | Marcel Yotebieng Lukas Fenner Haruka Uemura Jacqueline Huwa Ellen Brazier Marie Ballif Oliver Ezechi Anchalee Avihingsanon Denna Michael Jonathan Euvrard Guy Muula Nagalingeswaran Kumarasamy Lameck Diero Brian Otaalo Eric Komena Nicolas Banholzer Lisa Perrig Dominique Mahambu Nsonde Sarah Obatsa Patricia Lelo Patrice Gouéssé Idiovino Rafael Richard Ramdé I Ketut Agus Somia The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa BMJ Global Health |
| title | The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa |
| title_full | The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa |
| title_fullStr | The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa |
| title_full_unstemmed | The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa |
| title_short | The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa |
| title_sort | long term impact of the covid 19 pandemic on tuberculosis care and infection control measures in anti retroviral therapy art clinics in low and middle income countries a multiregional site survey in asia and africa |
| url | https://gh.bmj.com/content/10/3/e017828.full |
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