City of Cape Town Health Department, Specialised Health, HIV/STI/TB Unit, Cape Town, South Africa.
School of Public Health, University of Western Cape, Cape Town, South Africa.
PLoS One. 2024 Sep 11;19(9):e0310383. doi: 10.1371/journal.pone.0310383. eCollection 2024.
Coronavirus disease (COVID-19) negatively impacted tuberculosis (TB) programs which were already struggling to meet End-TB targets globally. We aimed to quantify and compare diagnosis, treatment initiation, treatment success, and losses along this TB care cascade for drug-susceptible TB in Cape Town, South Africa, prior to and during COVID-19.
This observational study used routine TB data within two predefined cohorts: pre-COVID-19 (1 October 2018-30 September 2019) and during-COVID-19 (1 April 2020-31 March 2021). The numbers of people diagnosed, treated for TB and successfully treated were received from the Western Cape Provincial Health Data Centre. Pre and post treatment loss to follow up and cascade success rates (proportion of individuals diagnosed with an outcome of treatment success) were calculated and compared across cohorts, disaggregated by sex, age, HIV status, TB treatment history and mode of diagnosis.
There were 27,481 and 19,800 individuals diagnosed with drug-susceptible TB in the pre- and during-COVID-19 cohorts respectively, a relative reduction of 28% (95% CI [27.4% - 28.5%]). Initial loss to follow up increased from 13.4% to 15.2% (p<0.001), while post treatment loss increased from 25.2% to 26.1% (p < 0.033). The overall cascade success rate dropped by 2.1%, from 64.8% to 62.7% (p< 0.001). Pre- and during-COVID-19 cascade success rates were negatively associated with living with HIV and having recurrent TB.
An already poorly performing TB program in Cape Town was negatively impacted by the COVID-19 pandemic. There was a substantial reduction in the number of individuals diagnosed with drug-susceptible. Increases in pre-and post-treatment losses resulted in a decline in TB cascade success rates. Strengthened implementation of TB recovery plans is vital, as health services now face an even greater gap between achievements and targets and will need to become more resilient to possible future public health disruptions.
冠状病毒病（COVID-19）对结核病（TB）项目产生了负面影响，这些项目已经在努力实现全球结核病终结目标。我们旨在量化和比较在南非开普敦，COVID-19 之前和期间，耐多药结核病（TB）在诊断、治疗启动、治疗成功和治疗过程中的损失。
这项观察性研究使用了两个预先定义的队列中的常规 TB 数据：COVID-19 之前（2018 年 10 月 1 日至 2019 年 9 月 30 日）和 COVID-19 期间（2020 年 4 月 1 日至 2021 年 3 月 31 日）。从西开普省卫生数据中心收到诊断、治疗结核病和成功治疗的人数。计算并比较了两个队列的治疗前和治疗后失访率以及级联成功率（诊断出治疗成功结果的个体比例），并按性别、年龄、HIV 状况、TB 治疗史和诊断方式进行了分类。
COVID-19 之前和期间分别有 27481 人和 19800 人被诊断为耐多药结核病，相对减少了 28%（95%CI [27.4%-28.5%]）。初始失访率从 13.4%增加到 15.2%（p<0.001），而治疗后失访率从 25.2%增加到 26.1%（p<0.033）。总体级联成功率下降了 2.1%，从 64.8%降至 62.7%（p<0.001）。COVID-19 之前和期间的级联成功率与 HIV 共存和复发性结核病呈负相关。
开普敦已经表现不佳的结核病项目受到 COVID-19 大流行的负面影响。被诊断患有耐多药结核病的人数大幅减少。治疗前和治疗后损失的增加导致结核病级联成功率下降。加强结核病恢复计划的实施至关重要，因为卫生服务机构现在面临着更大的成就与目标之间的差距，并且需要更加有弹性以应对可能的未来公共卫生中断。
