The COVID-19 pandemic has caused major disruption in healthcare delivery. For African countries, this disruption is likely to affect the control of seasonal infectious diseases, such as malaria, and vaccine preventable diseases. One of the major diseases likely to be affected is tuberculosis. In a Nature Medicine correspondence,
CDT-Africa has highlighted the need to continue vigorously the “fight to end tuberculosis”1 (https://www.nature.com/articles/s41591-020-0917-1). The paper notes three major challenges and offers potential solutions.
- The directly observed therapy is less likely to be practical. The current recommendation of going back to self-administered therapy will risk returning to the old problems. CDT-Africa has designed a multicentre, randomized, controlled trial to evaluate the effectiveness of implementation of an event reminder monitoring electronic device as an aid to assist with treatment concordance2.
- Disruption in drug supply chain: Monitoring of stocks and ensuring that there is adequate supply for a reasonable period of time is essential.
- Misdiagnosis: As a respiratory disease, tuberculosis may be diagnosed as COVID-19 when both occur together or when appropriate testing has not been done. Clinical studies are needed to evaluate co-occurrence and appropriate treatment for this group of patients.
According to a modelling work by the WHO (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen), in a worst case scenario, “a 6-month disruption of antiretroviral therapy…could lead to more than 500 000 extra deaths from AIDS-related illnesses, including from tuberculosis, in sub-Saharan Africa over the next year.” It is extremely important not to forget these and similar conditions that may actually lead to more death and longer term burden on the health service system.
- Manyazewal T, Woldeamanuel Y, Blumberg HM, Fekadu A, Marconi VC. The fight to end tuberculosis must not be forgotten in the COVID-19 outbreak. Nature Medicine. 2020.
- Manyazewal T, Woldeamanuel Y, Holland DP, Fekadu A, Blumberg HM, Marconi VC. Electronic pillbox-enabled self-administered therapy versus standard directly observed therapy for tuberculosis medication adherence and treatment outcomes in Ethiopia (SELFTB): protocol for a multicenter randomized controlled trial. Trials. 2020;21(1):383.