Crowder Rebecca, Geocaniga-Gaviola Donna Mae, Fabella Ronald Allan, Lim Alexander, Lopez Evanisa, Kadota Jillian L, Reza Tania F, Cattamanchi Adithya, Garfin Anna Marie Celina
Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA.
Disease Prevention and Control Bureau, Department of Health, Manila, Philippines.
J Clin Tuberc Other Mycobact Dis. 2021 Dec;25:100282. doi: 10.1016/j.jctube.2021.100282. Epub 2021 Oct 16.
Policies implemented to slow transmission of COVID-19 are expected to have disrupted delivery of routine health services, including tuberculosis (TB) care.
We analyzed daily counts of drug-susceptible (DS)-TB case notifications from all health facilities affiliated with the Philippines National TB Program (NTP) before and after implementation of community quarantine (January 1-December 31, 2020). Using an interrupted time series design, we assessed the immediate and sustained effects of community quarantine on TB case reporting. Using 2019 WHO estimates of national TB incidence, treatment, and mortality rates for the Philippines, we modeled excess mortality from TB, assuming a national decline in TB case reporting were extended for 12 months, followed by a return to pre-community quarantine trends.
The analysis included 192,918 DS-TB case notifications from 2,986 facilities located in 113 provinces and highly urbanized cities across 17 regions and covered 49 observations days before and 174 days after community quarantine implementation. We found an significant drop and steeper decline in daily TB case notifications after the implementation of community quarantine, resulting in 44.6% (95% CI 38.3-50.1) fewer daily TB case notifications 60 days after implementation of community quarantine. During 2020, DS-TB case notifications never returned to pre-quarantine levels. Assuming a 12-month disruption of TB case reporting, we estimate there will be 56.3% increase in TB-related deaths in the Philippines.
Modified delivery of TB prevention and care should be prioritized alongside efforts to combat COVID-19.
为减缓新冠病毒病（COVID-19）传播而实施的政策预计会扰乱包括结核病（TB）护理在内的常规卫生服务的提供。
我们分析了菲律宾国家结核病规划（NTP）下属所有卫生机构在实施社区隔离前后（2020年1月1日至12月31日）每日报告的药物敏感型（DS）结核病病例数。采用中断时间序列设计，我们评估了社区隔离对结核病病例报告的即时和持续影响。利用世界卫生组织（WHO）2019年对菲律宾全国结核病发病率、治疗率和死亡率的估计，我们模拟了结核病的超额死亡率，假设全国结核病病例报告下降持续12个月，随后恢复到社区隔离前的趋势。
分析纳入了来自17个地区113个省和高度城市化城市的2986个机构的192,918例DS结核病病例报告，涵盖社区隔离实施前49个观察日和实施后174个观察日。我们发现社区隔离实施后每日结核病病例报告显著下降且下降幅度更大，导致社区隔离实施60天后每日结核病病例报告减少44.6%（95%CI 38.3 - 50.1）。2020年期间，DS结核病病例报告从未恢复到隔离前水平。假设结核病病例报告中断12个月，我们估计菲律宾与结核病相关的死亡人数将增加56.3%。
在抗击COVID-19努力的同时，应优先考虑调整结核病预防和护理的提供方式。
