Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January–April 2020

Giovanni Battista Migliori; Pei Min Thong; Onno Akkerman; Jan-Willem Alffenaar; Fernando Álvarez-Navascués; Mourtala Mohamed Assao-Neino; Pascale Valérie Bernard; Joshua Sorba Biala; François-Xavier Blanc; Elena M. Bogorodskaya; Sergey Borisov; Danilo Buonsenso; Marianne Calnan; Paola Francesca Castellotti; Rosella Centis; Jeremiah Muhwa Chakaya; Jin-Gun Cho; Luigi Ruffo Codecasa; Lia D'Ambrosio; Justin Denholm; Martin Enwerem; Maurizio Ferrarese; Tatiana Galvão; Marta García-Clemente; José-María García-García; Gina Gualano; José Antonio Gullón-Blanco; Sandra Inwentarz; Giuseppe Ippolito; Heinke Kunst; Andrei Maryandyshev, Mario Melazzini, Fernanda Carvalho de Queiroz Mello, Marcela Muñoz-Torrico; Patrick Bung Njungfiyini; Domingo Juan Palmero; Fabrizio Palmieri; Pavilio Piccioni; Alberto Piubello; Adrian Rendon; Josefina Sabriá; Matteo Saporiti; Paola Scognamiglio; Samridhi Sharma; Denise Rossato Silva; Mahamadou Bassirou Souleymane; Antonio Spanevello; Eva Tabernero; Marina Tadolini; Michel Eke Tchangou; Alice Boi Yatta Thornton; Simon Tiberi; Zarir F. Udwadia; Giovanni Sotgiu; Catherine Wei Min Ong; Delia Goletti


Emerging Infectious Diseases. 2020;26(11):2709-2712. 

In This Article

The Study

We invited 37 TB centers to participate in the study and collected data from 33 centers located in 16 countries on 5 continents (Appendix Tables 1, 2, The participating centers received ethics clearance according to their respective center regulations.[7,8] Active TB disease and latent TB infection (LTBI) were defined according to international guidelines.[9,10] We recorded numbers of patients with active TB discharged from inpatient care, patients with newly diagnosed cases of active TB, patients with active TB visiting outpatient settings, and new and total outpatient visits for LTBI. We defined use of telehealth services as implementation of directly observed therapy during face-to-face virtual teleconsultations, which were considered to be equivalent to outpatient visits and were counted as such. We did not consider patient contact by telephone and emails to be telehealth. Home visits were considered outpatient visits. We also recorded national lockdown dates. If a country reported results from >1 center, we used the sum of the attendances to generate the graphs. Quantitative variables were summarized with absolute (percentage) frequencies.

Of the 16 countries studied, data were contributed by 4 TB centers each in Italy, Russia, Spain, and Brazil; 3 each in Sierra Leone and Niger; 2 in Mexico; and 1 each in 9 other countries (Appendix Tables 1, 2). Lockdowns were imposed in all countries (Appendix Figures 1, 2). The earliest lockdown start date was February 1, 2020 (Australia); the latest was April 7, 2020 (Singapore). By the end of data collection (April 30), none of the 16 countries had reduced lockdown severity.

Data on new active TB cases were available from 32 of the 33 TB centers. Except for 5 centers (Sydney, New South Wales, Australia; San Fernando, the Philippines; Turin, Italy; Asturias, Spain; and London, UK), which each reported stable numbers or moderate increases, new active TB cases decreased in 27 (84%) of the 32 TB centers in the first 4 months of 2020 relative to the same period in 2019 (Appendix Figure 1).

Information about total outpatient TB visits was available for 29 centers but not from Groningen, the Netherlands; Mexico City, Mexico; Porto Alegre, Brazil, and Nairobi, Kenya. A total of 22 (75%) of 29 TB centers from 14 countries registered decreased outpatient visits during the lockdowns.

Active TB–associated hospital discharges differed in 2020 from 2019. Although data were not available for a few centers (Buenos Aires, Argentina; Nairobi; and the 3 centers in Niger), data for San Fernando, Singapore; Mexico City, Groningen, and London indicated minimal or no increase. Active TB–associated hospital discharges for the remaining 23 (82%) of 28 TB centers were lower during the first 4 months of 2020.

Data for LTBI outpatient visits were available from 16 of the 33 TB centers; 13 (81%) recorded decreased total outpatient visits (all except Hastings, Sierra Leone; Alvorada, Brazil; and Barcelona, Spain) (Appendix Figure 2). Data for newly diagnosed LTBIs were available from 19 of the 33 TB centers. New LTBI outpatient visits at 18 (95%) of 19 TB centers (all except Alvorada) were fewer during the lockdown period (Appendix Figure 2).

During the first 4 months of 2020, telehealth services were used by 7 (21%) of the 33 TB centers. The number of patients using telehealth services was reported by 4 centers: Sydney; Mumbai, India; London; and Arkhangelsk, Russia. Increased use of telehealth services correlated with lockdown implementation; most uses were recorded in April 2020 (Appendix Tables 1, 2).