51% Indians with TB Less Likely To Seek Care During COVID: Report

As India and the world continue to grapple with the challenges posed by the COVID-19 pandemic, the fight against other diseases seems to have taken a backseat.

There is now growing consensus on the several ways in which the response to the coronavirus pandemic has impacted the lives of people living with tuberculosis (TB). From barriers in getting tested, seeking care, and facing stigma on a double front, TB patients have been suffering.

The Global Coalition of TB Activists (GCTA) along with a diverse group of advocacy networks let a survey aiming to measure this impact towards five stakeholder groups: frontline healthcare workers, policy and program officers, TB researchers, TB survivors or advocates, and people currently on treatment for TB.

Over 1000 people from 89 countries around the world participated by sharing their observations and experiences related to resource availability and constraints, as well as challenges and opportunities.

Some global findings from the report, titled “The Impact of the COVID-19 on the TB Epidemic”:

• Globally, more than 70% of healthcare workers reported a decrease in the number of people coming to health facilities for TB testing.
• Over 50% of healthcare workers reported the healthcare facility they worked at to have decreased TB services.
• 57% of TB researchers reported that they did not have the necessary resources to conduct important TB research during the pandemic.
• 34% of the researchers said their funding for TB had decreased since the beginning of the outbreak.

At the India launch of the report on 24 September, some glaring numbers were revealed. Out of the above-mentioned stakeholders, Indians composed of 58 out of 237 people currently on TB treatment, 10 out of 171 healthcare workers, 14 out of 136 policy and program officers and 8 out of 73 TB researchers.

• 51% of people with TB were less likely to seek care during the pandemic.
• 62% of them were concerned that they might get COVID-19 if they did visit a clinic.
• 36% of them reported health facilities they normally visit closed.
• 28% of people with TB reported feeling stigmatized due to similar symptoms of COVID-19 and TB.
• 51% of Indian participants said they were given medicine to continue their treatment at home.

The report calls for governments to rebuild patient-centered healthcare systems where people with TB can seek care, and to ensure health facilities can provide quality TB care through providers within the universal healthcare (UHC) framework, across all government levels, mobilizing both the public and private health sectors, including community-based groups. The following recommendations are made:

• Protect the healthcare workforce with a safe working environment and enough PPE, as well as free mental-health support and resources.
• Ensure that all people with TB have access to medicines (at least 2–3 months’ supply); switch to the shorter, all-oral drug regimens, as recommended by the WHO; and set up alternative medication delivery networks, such as courier services.
• Leverage testing platforms to increase COVID-19 testing capacity while ensuring that TB testing is not stopped; TB programs must continue running the Xpert mycobacterium tuberculosis/resistance to rifampicin (MTB/RIF) TB test, which is critical to early detection of drug-resistant TB in many settings.
• Invest in the overall capacity of health systems, with increased attention on community-led initiatives and community health workers, including TB survivors, to provide peer-to-peer patient support via digital and mobile platforms.
• Researchers must support governments with evidence-based research on healthcare capacity to care for TB patients during the pandemic.

On a positive note, the report highlights the opportunities that the response to the COVID-19 outbreak provide for promptly managing other diseases as well. “All groups identified an opportunity to strengthen the TB response during the pandemic: Investments in COVID-19, such as in contract-tracing or diagnostic capacity, can be leveraged for TB, while heightened interest in and awareness of infectious respiratory diseases and global health offer an entry point for increasing the political will to end TB.”