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      Patient, Diagnosis, and Treatment Delays Among Tuberculosis Patients Before and During COVID-19 Epidemic — China, 2018–2022

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          Abstract

          What is already known about this topic?

          The coronavirus disease (COVID-19) pandemic could have a damaging impact on access to tuberculosis (TB) diagnosis and treatment.

          What is added by this report?

          The overall delay experienced by TB patients during the COVID-19 pandemic has shown a modest decrease in comparison to the period before the pandemic. Notably, higher patient delays were observed among agricultural workers and those identified through passive case-finding methods. Furthermore, the patient delay in eastern regions was shorter compared to western and central regions.

          What are the implications for public health practice?

          The observed increase in patient delay in 2022 should be of concern for ongoing TB control efforts. Health education and active screening initiatives must be enhanced and broadened among high-risk populations and regions characterized by extended patient delays.

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          Most cited references7

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          Tuberculosis in Migrant Populations. A Systematic Review of the Qualitative Literature

          Bruno Abarca Tomás, Christopher Pell, Aurora Bueno Cavanillas … (2013)
          Background The re-emergence of tuberculosis (TB) in low-incidence countries and its disproportionate burden on immigrants is a public health concern posing specific social and ethical challenges. This review explores perceptions, knowledge, attitudes and treatment adherence behaviour relating to TB and their social implications as reported in the qualitative literature. Methods Systematic review in four electronic databases. Findings from thirty selected studies extracted, tabulated, compared and synthesized. Findings TB was attributed to many non-exclusive causes including air-born transmission of bacteria, genetics, malnutrition, excessive work, irresponsible lifestyles, casual contact with infected persons or objects; and exposure to low temperatures, dirt, stress and witchcraft. Perceived as curable but potentially lethal and highly contagious, there was confusion around a condition surrounded by fears. A range of economic, legislative, cultural, social and health system barriers could delay treatment seeking. Fears of deportation and having contacts traced could prevent individuals from seeking medical assistance. Once on treatment, family support and “the personal touch” of health providers emerged as key factors facilitating adherence. The concept of latent infection was difficult to comprehend and while TB screening was often seen as a socially responsible act, it could be perceived as discriminatory. Immigration and the infectiousness of TB mutually reinforced each another exacerbating stigma. This was further aggravated by indirect costs such as losing a job, being evicted by a landlord or not being able to attend school. Conclusions Understanding immigrants’ views of TB and the obstacles that they face when accessing the health system and adhering to a treatment programme-taking into consideration their previous experiences at countries of origin as well as the social, economic and legislative context in which they live at host countries- has an important role and should be considered in the design, evaluation and adaptation of programmes.
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            The impact of the COVID-19 epidemic on tuberculosis control in China

            Huang Fei, Xia Yinyin, Chen Hui … (2020)
            Background In response to the COVID-19 epidemic, China implemented a series of interventions that impacted tuberculosis (TB) control in the country. Methods Based on routine surveillance data and questionnaires, the study analyzed TB notification, follow-up examinations, and treatment outcomes. The data were split into three phases in relation to outbreak, lockdown and reopen when the nationwide COVID-19 response started in 2020: control (11 weeks prior), intensive (11 weeks during and immediately after), and regular (4 additional weeks). Data from 2017–2019 were used as baseline. Findings The notified number of TB patients decreased sharply in the 1st week of the intensive period but took significantly longer to rebound in 2020 compared with baseline. The percentages of TB patients undergoing sputum examination within one week after 2 months treatment and full treatment course in the intensive period were most affected and decreased by 8% in comparison with control period. 75•2% (221/294) of counties reallocated CDC and primary health care workers to fight the COVID-19 epidemic, 26•9% (725/2694) of TB patients had postponed or missed their follow-up examinations due to travel restrictions and fear of contracting COVID-19. Interpretation In the short term, the COVID-19 epidemic mostly affected TB notification and follow-up examinations in China, which may lead to a surge of demand for TB services in the near future. To cope with this future challenge, an emergency response mechanism for TB should be established. Funding National Health Commission of China–Bill & Melinda Gates Foundation TB Collaboration project (OPP1137180).
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              Total Delay Is Associated with Unfavorable Treatment Outcome among Pulmonary Tuberculosis Patients in West Gojjam Zone, Northwest Ethiopia: A Prospective Cohort Study

              Senedu Bekele Gebreegziabher, Gunnar Aksel Bjune, Solomon Yimer (2016)
              Background delay in diagnosis and treatment of tuberculosis (TB) may worsen the disease, increase mortality and enhance transmission in the community. This study aimed at assessing the association between total delay and unfavorable treatment outcome among newly diagnosed pulmonary TB (PTB) patients. Methods A prospective cohort study was conducted in West Gojjam Zone, Amhara Region of Ethiopia from October 2013 to May 2015. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study from 30 randomly selected public health facilities. Total delay (the time period from onset of TB symptoms to first start of anti-TB treatment) was measured. Median total delay was calculated. Mixed effect logistics regression was used to analyze factors associated with unfavorable treatment outcome. Results Seven hundred six patients were enrolled in the study. The median total delay was 60 days. Patients with total delay of > 60 days were more likely to have unfavorable TB treatment outcome than patients with total delay of ≤ 60 days (adjusted odds ratio [AOR], 2.33; 95% confidence interval [CI], 1.04–5.26). Human immunodeficiency virus (HIV) positive TB patients were 8.46 times more likely to experience unfavorable treatment outcome than HIV negative TB patients (AOR, 8.46; 95% CI, 3.14–22.79). Conclusions Long total delay and TB/HIV coinfection were associated with unfavorable treatment outcome. Targeted interventions that can reduce delay in diagnosis and treatment of TB, and early comprehensive management of TB/HIV coinfection are needed to reduce increased risk of unfavorable treatment outcome.
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                Author and article information

                Contributors
                Yanlin Zhao
                Journal
                Journal ID (nlm-ta): China CDC Wkly
                Journal ID (publisher-id): CCDCW
                Title: China CDC Weekly
                Publisher: Editorial Office of CCDCW, Chinese Center for Disease Control and Prevention (Beijing, China )
                ISSN (Electronic): 2096-7071
                Publication date (Print): 24 March 2023
                Volume: 5
                Issue: 12
                Pages: 259-265
                Affiliations
                [1 ] National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
                [2 ] School of Public Health, Peking University, Beijing, China
                [3 ] Department of Public Health, Hangzhou Medical College, Hangzhou City, Zhejiang Province, China
                Author notes
                Article
                Publisher ID: ccdcw-5-12-259
                DOI: 10.46234/ccdcw2023.047
                PMC ID: 10150750
                PubMed ID: 37138894
                SO-VID: 18e0c6b6-b22c-4fce-a32e-d3b4aa7f7bdd
                Copyright © Copyright and License information: Editorial Office of CCDCW, Chinese Center for Disease Control and Prevention 2023
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/

                History
                Date received : 7 March 2023
                Date accepted : 22 March 2023
                Categories
                Subject: Preplanned Studies

                Keywords: delays,tuberculosis,notification,doi: 10.46234/ccdcw2023.038
                Data availability:
                Keywords: delays, tuberculosis, notification, doi: 10.46234/ccdcw2023.038

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