A study today in BMC Medicine highlights the toll that the COVID-19 pandemic has taken on the diagnosis of tuberculosis (TB) in high-burden countries, particularly in vulnerable populations.
To assess the impact of the pandemic on TB services, members of the TB Modelling Group at the London School of Hygiene & Tropical Medicine (LSHTM) modeled trends in age- and sex-disaggregated case notifications for all forms of new and relapse TB reported to the World Health Organization for 45 high TB, TB/HIV, and multidrug-resistant (MDR)-TB burden countries from 2013 through 2019. They then compared the trends predicted for 2020 with actual observed notifications that year and assessed disparities by age and sex.
Overall, more than 1.5 million people in the 45 countries were estimated to have had a missed or delayed TB diagnosis in 2020 because of COVID-19 disruptions, including 195,449 children, 1,126,133 people aged 15 to 64 years, and 235,402 individuals aged 65 years or older.
While the study found no evidence globally that the risk of having a missed or delayed TB diagnosis in 2020 was different for children and adults (risk ratio [RR], 1.09; 95% confidence interval [CI], 0.41 to 2.91), the elderly and younger adults (RR, 1.40; 95% CI, 0.62 to 3.16), or men and women (RR, 0.59; 95% CI, 0.25 to 1.42), there was some evidence of disparities when broken down by country.
In over half of the countries (57.1%) analyzed, for example, children were at greater risk of a missed or delayed TB diagnosis, while in 70.1% of countries, those aged 65 or older had a greater risk. In 45% of countries, sex was predicted to be an influential factor.
The study authors say the findings could aid efforts to mitigate the effects of the pandemic on TB services.
"Population groups whose access to TB diagnosis was disproportionately affected by the COVID-19 pandemic should be prioritised in catch-up campaigns," study co-author Katherine Horton, PhD, MPH, said in an LHSTM press release.
"For example, in settings where children have missed diagnoses, school-based strategies may be useful, while gender-sensitive strategies should be implemented in settings where one sex has been relatively under-diagnosed."