Caminada Susanna, Benoni Roberto, Dente Maria Grazia, Robbiati Claudia, Tomas Joaquim, Natali Giulia, De Simeis Luca, Da Silvia Nsuka, Lazary Neusa, Tienabe Paulo Siene, Putoto Giovanni, Costanzo Marianna, Manenti Fabio, Tosti Maria Elena
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
National Center for Global Health, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy.
Front Public Health. 2025 Apr 24;13:1530782. doi: 10.3389/fpubh.2025.1530782. eCollection 2025.
The SARS-CoV-2 pandemic had a profound impact on healthcare systems worldwide. In sub-Saharan Africa, it significantly affected several health services for infectious diseases such as HIV; however, less is known about its impact on Tuberculosis (TB). This study aimed to assess the pandemic's impact on access to health services in Angola, focusing on diagnosis and treatment services for TB.
An observational study combining data from routine statistics and surveys based on ad-hoc questionnaires was conducted on TB and non-TB services between 2018 and 2022. On routine data, temporal trends were analyzed comparing different non TB- and TB-specific indicators across the five-year period using the chi-square test. Questionnaires were administered to healthcare professionals from TB/non-TB services and structured interviews were conducted with TB patients to understand their perceptions about the impact of COVID-19 pandemic.
There was a significant decline in access to TB services during the pandemic, with a substantial decrease in reported cases (-15.5% in 2020; -18.3% in 2021) and treatment rate (from 86% in 2019 to 68% in 2020), an increase in multidrug-resistant-TB (from 0.2% in 2018 to 2.1% in 2022) and TB/HIV co-infections (from 6% in 2018 to 8.8% in 2021). The impact was most pronounced in the province of Luanda (capital city). TB services in Angola were disproportionately affected compared to general healthcare access indicators. The healthcare professionals' and patients' questionnaires showed that fear of COVID-19, unavailability of drugs, reduced income, and transportation challenges were the main barriers to healthcare access.
The COVID-19 pandemic negatively impacted the TB services provision in Angola. This highlights the urgent need for health systems to develop robust contingency plans to ensure the continuity of TB services during and after public health crises and to maintain essential healthcare services by supporting the healthcare workforce and addressing barriers to patient access.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行对全球医疗系统产生了深远影响。在撒哈拉以南非洲，它严重影响了一些传染病的医疗服务，如艾滋病毒；然而，关于其对结核病（TB）的影响知之甚少。本研究旨在评估该大流行对安哥拉医疗服务可及性的影响，重点关注结核病的诊断和治疗服务。
在2018年至2022年期间，对结核病和非结核病服务开展了一项观察性研究，该研究结合了常规统计数据和基于特设问卷的调查数据。对于常规数据，使用卡方检验分析了五年期间不同的非结核病和结核病特定指标的时间趋势。对结核病/非结核病服务的医护人员进行了问卷调查，并对结核病患者进行了结构化访谈，以了解他们对2019冠状病毒病大流行影响的看法。
在大流行期间，结核病服务的可及性显著下降，报告病例大幅减少（2020年下降15.5%；2021年下降18.3%），治疗率下降（从2019年的86%降至2020年的68%），耐多药结核病增加（从2018年的0.2%增至2022年的2.1%），结核病/艾滋病毒合并感染增加（从2018年的6%增至2021年的8.8%）。这种影响在罗安达省（省会）最为明显。与一般医疗服务可及性指标相比，安哥拉的结核病服务受到的影响尤为严重。医护人员和患者的问卷调查显示，对2019冠状病毒病的恐惧、药品短缺、收入减少和交通困难是获得医疗服务的主要障碍。
2019冠状病毒病大流行对安哥拉的结核病服务提供产生了负面影响。这凸显了卫生系统迫切需要制定强有力的应急计划，以确保在公共卫生危机期间及之后结核病服务的连续性，并通过支持医护人员和消除患者就医障碍来维持基本医疗服务。
