Martin-Hughes Rowan, Vu Lung, Cheikh Nejma, Kelly Sherrie L, Fraser-Hurt Nicole, Shubber Zara, Manhiça Ivan, Mbendera Kuzani, Girma Belaineh, Pambudi Imran, Ríos Julia, Elmira Abdrahmanova, Harimurti Pandu, Hafez Reem, Garcia Jaime Nicolas Bayona, Palmer Tom, Roberts Anna, Gorgens Marelize, Wilson David
Burnet Institute, Melbourne, Victoria, Australia.
The World Bank, N.W. Washington, DC, United States of America.
PLOS Glob Public Health. 2022 Mar 30;2(3):e0000219. doi: 10.1371/journal.pgph.0000219. eCollection 2022.
Initial global-level estimates reported in June 2020 by the World Health Organization suggested that levels of disruption to TB service delivery could be as high as 25%-50% and result in an additional 6·3 million cases of tuberculosis (TB) and an additional 1·4 million TB-related deaths attributable to COVID-19 between 2020 and 2025. Quarterly epidemiological estimates and programmatic TB data capturing disruption levels to each TB service were collected by National TB Programmes in Indonesia, Kyrgyzstan, Malawi, Mozambique, and Peru. Data from 2019, for a pre-COVID-19 baseline, and throughout 2020, together with the NTP's COVID-19 response plans, were used within Optima TB models to project TB incidence and deaths over five years because of COVID-19-related disruptions, and the extent to which those impacts may be mitigated through proposed catch-up strategies in each country. Countries reported disruptions of up to 64% to demand-driven TB diagnosis. However, TB service availability disruptions were shorter and less severe, with TB treatment experiencing levels of disruption of up to 21%. We predicted that under the worse-case scenario cumulative new latent TB infections, new active TB infections, and TB-related deaths could increase by up to 23%, 11%, and 20%, respectively, by 2024. However, three of the five countries were on track to mitigate these increases to 3% or less by maintaining TB services in 2021 and 2022 and by implementing proposed catch-up strategies. Indonesia was already experiencing the worse-case scenario, which could lead to 270,000 additional active TB infections and 36,000 additional TB-related deaths by the end of 2024. The COVID-19 pandemic is projected to negatively affect progress towards 2035 End TB targets, especially in countries already off-track. Findings highlight both successful TB service delivery adaptions in 2020 and the need to proactively maintain TB service availability despite potential future waves of more transmissible COVID-19 variants.
世界卫生组织2020年6月发布的初步全球层面估计显示，结核病服务提供中断水平可能高达25%-50%，并将在2020年至2025年间导致新增630万例结核病病例以及另外140万例与结核病相关的死亡，这些死亡归因于新冠疫情。印度尼西亚、吉尔吉斯斯坦、马拉维、莫桑比克和秘鲁的国家结核病规划收集了季度流行病学估计数据以及记录每项结核病服务中断水平的结核病规划数据。2019年（作为新冠疫情前的基线）以及2020年全年的数据，连同国家结核病规划的新冠疫情应对计划，被用于Optima结核病模型中，以预测因新冠疫情相关中断导致的五年内结核病发病率和死亡情况，以及通过各国提议的追赶策略可在多大程度上减轻这些影响。各国报告需求驱动的结核病诊断中断率高达64%。然而，结核病服务可及性中断持续时间较短且程度较轻，结核病治疗的中断水平高达21%。我们预测，在最坏情况下，到2024年，累积的新潜伏性结核感染、新活动性结核感染以及与结核病相关的死亡可能分别增加高达23%、11%和20%。然而，五个国家中有三个有望通过在2021年和2022年维持结核病服务以及实施提议的追赶策略，将这些增加幅度降至3%或更低。印度尼西亚已经处于最坏情况，到2024年底可能导致额外27万例活动性结核感染和3.6万例与结核病相关的额外死亡。预计新冠疫情将对实现2035年终结结核病目标的进展产生负面影响，尤其是在那些已经偏离轨道的国家。研究结果凸显了2020年结核病服务提供方面成功的调整，以及尽管未来可能出现更具传播性的新冠病毒变种浪潮，仍需积极维持结核病服务可及性的必要性。
