Escuela de Ciencias de la Salud, Universidad Autónoma de Baja California, Ensenada, Mexico.
Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, CA, United States.
Front Public Health. 2022 Jul 22;10:921596. doi: 10.3389/fpubh.2022.921596. eCollection 2022.
In 2020, Mexico reported the lowest tuberculosis (TB) incidence on record, and it is unclear to what extent COVID-19 has impacted TB surveillance, diagnosis, and treatment. It is important to understand COVID-19's impact in Baja California (BC), which has the highest TB burden in Mexico. With the increasing number of migrants and asylum seekers arriving in BC, limited resources and crowded living conditions increase the risk of TB transmission. The purpose of this study was to assess the impact of COVID-19 on TB diagnosis and treatment in BC. We were also interested in health disparities experienced by migrants in BC. We conducted a mixed methods analysis using quantitative surveillance data obtained from the Mexico National TB Program (NTP) and qualitative data collected through in-depth interviews and focus group discussions with TB program directors and personnel in BC's four provincial health jurisdictions. Compared to the year prior, surveillance data from March 2020 - February 2021 revealed that TB incidence in BC declined by 30.9% and favorable TB outcomes (TB cure or treatment completion) declined by 49.8%. Elucidating differences by migrant status was complicated by the lack of standardized collection of migrant status by the NTP. Qualitative analysis revealed that TB diagnostic and treatment supplies and services became limited and disproportionately accessible across jurisdictions since the pandemic began; however, favorable adaptations were also reported, such as increased telemedicine use and streamlined care referral processes. Participants shared that migrant status is susceptible to misclassification and that TB care is difficult due to the transitory nature of migrants. This study did not identify major differences in TB service delivery or access between migrants and non-migrants in BC; however, migrant status was frequently missing. COVID-19 has overwhelmed health systems worldwide, disrupting timely TB diagnostic and treatment services, and potentially caused underdiagnosis of TB in BC. TB programs in BC should quickly restore essential services that were disrupted by COVID-19 while identifying and preserving beneficial program adaptations, such as telemedicine and streamlined care referral processes. Improved methods for documenting migrant status of TB cases are also needed.
2020 年，墨西哥报告了有记录以来最低的结核病（TB）发病率，目前尚不清楚 COVID-19 对 TB 监测、诊断和治疗的影响程度。了解墨西哥 TB 负担最重的下加利福尼亚州（BC）的 COVID-19 影响非常重要。随着越来越多的移民和寻求庇护者抵达 BC，有限的资源和拥挤的居住条件增加了 TB 传播的风险。本研究的目的是评估 COVID-19 对 BC 结核病诊断和治疗的影响。我们还对 BC 移民所经历的健康差距感兴趣。我们使用定量监测数据和定性数据进行了混合方法分析，定量监测数据来自墨西哥国家结核病规划（NTP），定性数据来自 BC 四个省级卫生管辖区的结核病规划主任和工作人员的深入访谈和焦点小组讨论。与前一年相比，2020 年 3 月至 2021 年 2 月的监测数据显示，BC 的结核病发病率下降了 30.9%，有利的结核病结果（结核病治愈或治疗完成）下降了 49.8%。由于 NTP 缺乏对移民身份的标准化收集，阐明移民身份的差异变得复杂。定性分析显示，自大流行开始以来，各个管辖区的结核病诊断和治疗用品和服务变得有限且不成比例地难以获得；然而，也报告了有利的适应措施，例如增加远程医疗的使用和简化护理转诊流程。参与者表示，移民身份容易被错误分类，由于移民的过境性质，TB 护理也很困难。本研究没有在下加利福尼亚州发现移民和非移民之间的 TB 服务提供或获得方面存在重大差异；然而，移民身份经常缺失。COVID-19 使全球卫生系统不堪重负，扰乱了及时的 TB 诊断和治疗服务，并可能导致 BC 结核病漏诊。BC 的结核病规划应迅速恢复因 COVID-19 而中断的基本服务，同时确定并保留远程医疗和简化护理转诊流程等有益的规划适应措施。还需要改进记录结核病病例移民身份的方法。
