Socios En Salud Sucursal Peru, Lima, Peru.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
BMC Infect Dis. 2022 Nov 9;22(1):829. doi: 10.1186/s12879-022-07832-2.
The COVID-19 pandemic disrupted TB services worldwide, leading to diagnostic delays. There have been few published reports describing how the pandemic affected people's pathway to diagnosis from their own perspectives. We sought to evaluate the impact on the pandemic on people's experiences obtaining a TB diagnosis.
We performed a mixed-methods study, enrolling newly diagnosed TB patients from 12 health centers in Lima, Peru. We used structured surveys to quantify diagnostic delay, defined as the time between symptom onset and diagnosis, and in-depth interviews to understand the ways in which the pandemic affected the pathway to care. We compared diagnostic delay between patients enrolled during the first year of the pandemic to those diagnosed after using a Wilcoxon rank-sum test. We used an inductive content analysis approach to analyze interview content related to the pandemic.
We enrolled 51 patients during November 2020-April 2021 (during the first year of the pandemic) and 49 patients during October 2021-February 2022. Median diagnostic delay was longer for patients diagnosed during the first year of the pandemic (median 15 [IQR 5-26] weeks compared to 6 [IQR 3-18] weeks, p = 0.027). Qualitative analysis of 26 interviews revealed that the pandemic affected participants' care-seeking behavior and their ability to access to TB diagnostic services, particularly for those diagnosed in the first year of the pandemic. Many participants initially had their symptoms attributed to COVID-19, resulting in delayed TB evaluation and additional costs for COVID-19 treatment.
The COVID-19 pandemic impacted multiple steps in the pathway to care for TB patients in Lima, causing delays in TB diagnosis. These findings demonstrate how the shifting of health care resources to prioritize COVID-19 can lead to collateral damage for people with TB and other conditions.
COVID-19 大流行在全球范围内扰乱了结核病服务，导致诊断延迟。很少有发表的报告描述大流行如何从人们自己的角度影响他们获得结核病诊断的途径。我们试图评估大流行对人们获得结核病诊断的经历的影响。
我们进行了一项混合方法研究，招募了来自秘鲁利马 12 个卫生中心的新诊断结核病患者。我们使用结构化调查来量化诊断延迟，定义为从症状出现到诊断的时间，并进行深入访谈以了解大流行如何影响护理途径。我们使用 Wilcoxon 秩和检验比较了大流行期间第一年和之后诊断的患者的诊断延迟。我们使用归纳内容分析方法分析与大流行相关的访谈内容。
我们在 2020 年 11 月至 2021 年 4 月（大流行的第一年）期间招募了 51 名患者，在 2021 年 10 月至 2022 年 2 月期间招募了 49 名患者。大流行第一年诊断的患者的中位诊断延迟时间更长（中位数 15 [IQR 5-26] 周与 6 [IQR 3-18] 周相比，p = 0.027）。对 26 次访谈的定性分析表明，大流行影响了参与者的寻医行为和他们获得结核病诊断服务的能力，尤其是在大流行的第一年诊断的参与者。许多参与者最初将其症状归因于 COVID-19，导致结核病评估延迟，并增加了 COVID-19 治疗费用。
COVID-19 大流行影响了利马结核病患者护理途径的多个步骤，导致结核病诊断延迟。这些发现表明，将卫生保健资源转移到优先考虑 COVID-19 会如何给结核病和其他疾病患者带来附带损害。
