“我同情结核病患者”：一项混合方法研究，评估了 COVID-19 大流行对印度尼西亚两个主要城市结核病服务的影响，并为未来总结了经验教训。

"I pity the TB patient": a mixed methods study assessing the impact of the COVID-19 pandemic on TB services in two major Indonesian cities and distilling lessons for the future.

机构信息

Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.

出版信息

BMJ Glob Health. 2024 May 16;9(5):e014943. doi: 10.1136/bmjgh-2023-014943.

DOI:10.1136/bmjgh-2023-014943

PMID:38760026

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11103193/

Abstract

INTRODUCTION

In Indonesia, a country with around 280 million people and the second-highest tuberculosis (TB) incidence rate in the world, the impact of the COVID-19 pandemic on TB care needs careful assessment so that future response strategies can be strengthened. We conducted a study comparing TB testing and treatment rates before and during the first 2 years of the COVID-19 pandemic in Indonesia, and the reasons for any disruptions to care.

METHODS

We conducted retrospective secondary data analysis and qualitative interviews in Yogyakarta and Bandung, Indonesia. Routine data on TB testing and treatment were sourced from the national TB information system operated by the Indonesian Ministry of Health. TB testing and treatment outcomes were compared between two time periods: pre-COVID (2018-19); and during COVID-19 (2020-21). In-depth interviews were conducted with patients and health workers to explore their experiences in accessing and providing TB services during the pandemic.

RESULTS

There was a 45% (21 937/39 962) reduction in the number of patients tested for TB during the pandemic compared with pre-COVID-19, while the proportion of TB tests returning a positive result increased from 12% (4733/39 962) to 50% (10 945/21 937). The proportion of TB patients completing treatment increased by 2.6% during the pandemic, yet the proportion cured and the number of patients successfully treated both decreased (by 7% and 4.4%, respectively). Our qualitative interviews highlighted several factors influencing TB service access and delivery, including fear of being diagnosed with COVID-19 during TB-related clinic visits, fear of COVID-19 exposure among patients and health workers, healthcare facilities prioritising COVID-19 over other services, and mandatory mobility restrictions affecting both patients and health workers.

CONCLUSION

The COVID-19 pandemic impacted TB testing and treatment outcomes in Bandung and Yogyakarta. Policymakers should consider these findings in designing strategies to ensure TB services are maintained and supported during future health crises.

摘要

简介

印度尼西亚是一个拥有 2.8 亿人口的国家，其结核病（TB）发病率居世界第二。因此，需要仔细评估 COVID-19 大流行对结核病防治工作的影响，以便加强未来的应对策略。我们进行了一项研究，比较了印度尼西亚 COVID-19 大流行前两年的结核病检测和治疗率，以及对医疗服务造成的任何中断的原因。

方法

我们在印度尼西亚的日惹和万隆进行了回顾性二次数据分析和定性访谈。国家结核病信息系统提供的结核病检测和治疗的常规数据由印度尼西亚卫生部运营。将结核病检测和治疗结果与两个时间段进行比较：COVID-19 大流行前（2018-19 年）和 COVID-19 大流行期间（2020-21 年）。对患者和卫生工作者进行深入访谈，以了解他们在大流行期间获得和提供结核病服务的经验。

结果

与 COVID-19 大流行前相比，大流行期间接受结核病检测的患者数量减少了 45%（21937/39962），而结核病检测呈阳性的比例从 12%（4733/39962）增加到 50%（10945/21937）。在大流行期间，完成结核病治疗的患者比例增加了 2.6%，但治愈比例和成功治疗的患者数量均有所下降（分别下降了 7%和 4.4%）。我们的定性访谈强调了影响结核病服务获取和提供的几个因素，包括在与结核病相关的诊所就诊时担心被诊断出 COVID-19，患者和卫生工作者担心感染 COVID-19，医疗机构将 COVID-19 置于其他服务之上，以及影响患者和卫生工作者的强制性流动性限制。