Risk factors for disruptions in tuberculosis care in Uganda during the COVID-19 pandemic.
Journal
PLOS global public health
ISSN: 2767-3375
Titre abrégé: PLOS Glob Public Health
Pays: United States
ID NLM: 9918283779606676
Informations de publication
Date de publication:
2023
2023
Historique:
received:
24
08
2022
accepted:
22
03
2023
medline:
2
6
2023
pubmed:
2
6
2023
entrez:
2
6
2023
Statut:
epublish
Résumé
During the COVID-19 pandemic, TB mortality increased while diagnoses decreased, likely due to care disruption. In March, 2020, Uganda-a country with high TB burden, implemented a COVID-19 lockdown with associated decrease in TB diagnoses. This study aims to examine patient level risk factors for disruption in TB care during the COVID-19 pandemic in Uganda. This retrospective cross-sectional cohort study included six TB clinics in Uganda. Clustered sampling included phases of TB care and three time-periods: pre-lockdown, lockdown and post-lockdown. Characteristics of patients with TB care disruption (TBCD), defined as those with > 2 months of symptoms prior to diagnosis or who missed a TB clinic, and those without TB care disruption (non-TBCD) were analyzed between time-periods. 1,624 charts were reviewed; 1322 were contacted, 672 consented and completed phone interview; pre-lockdown (n = 213), lockdown (n = 189) and post-lockdown (n = 270). TBCD occurred in 57% (385/672) of patients. There was an increase in the proportion of urban patients in the TBCD and non-TBCD groups during post-lockdown (p <0.001). There was no difference in demographics, HIV co-infection, socioeconomic status, or distance to TB clinic between TBCD and non-TBCD groups or within TBCD by time-period. There were few differences amongst TBCD and all TB patients by time-period. The increase in urban patients' post-lockdown may represent a portion of urban patients who delayed care until post-lockdown. Insignificant trends suggesting more TBCD amongst those who lived further from clinics and those without HIV-coinfection require more investigation.
Sections du résumé
BACKGROUND
BACKGROUND
During the COVID-19 pandemic, TB mortality increased while diagnoses decreased, likely due to care disruption. In March, 2020, Uganda-a country with high TB burden, implemented a COVID-19 lockdown with associated decrease in TB diagnoses. This study aims to examine patient level risk factors for disruption in TB care during the COVID-19 pandemic in Uganda. This retrospective cross-sectional cohort study included six TB clinics in Uganda. Clustered sampling included phases of TB care and three time-periods: pre-lockdown, lockdown and post-lockdown. Characteristics of patients with TB care disruption (TBCD), defined as those with > 2 months of symptoms prior to diagnosis or who missed a TB clinic, and those without TB care disruption (non-TBCD) were analyzed between time-periods. 1,624 charts were reviewed; 1322 were contacted, 672 consented and completed phone interview; pre-lockdown (n = 213), lockdown (n = 189) and post-lockdown (n = 270). TBCD occurred in 57% (385/672) of patients. There was an increase in the proportion of urban patients in the TBCD and non-TBCD groups during post-lockdown (p <0.001). There was no difference in demographics, HIV co-infection, socioeconomic status, or distance to TB clinic between TBCD and non-TBCD groups or within TBCD by time-period. There were few differences amongst TBCD and all TB patients by time-period. The increase in urban patients' post-lockdown may represent a portion of urban patients who delayed care until post-lockdown. Insignificant trends suggesting more TBCD amongst those who lived further from clinics and those without HIV-coinfection require more investigation.
Identifiants
pubmed: 37267249
doi: 10.1371/journal.pgph.0001573
pii: PGPH-D-22-01394
pmc: PMC10237487
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e0001573Informations de copyright
Copyright: © 2023 Jackson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
N Engl J Med. 2022 Apr 21;386(16):1490-1493
pubmed: 34986295
BMC Public Health. 2008 Jan 14;8:15
pubmed: 18194573
Am J Public Health. 2007 Mar;97(3):470-7
pubmed: 17018825
EClinicalMedicine. 2020 Oct 24;28:100603
pubmed: 33134905
Health Policy. 1996 Jul;37(1):53-72
pubmed: 10158943
Confl Health. 2021 Nov 3;15(1):79
pubmed: 34732235
PLoS Med. 2007 Feb;4(2):e37
pubmed: 17298164
Int J Tuberc Lung Dis. 2005 Dec;9(12):1349-54
pubmed: 16466057
PLoS Med. 2018 Jul 3;15(7):e1002595
pubmed: 29969463
Emerg Infect Dis. 2021 Jul;27(7):1831-1839
pubmed: 34152962
Int J Environ Res Public Health. 2022 Sep 30;19(19):
pubmed: 36231823
Chest. 2007 Nov;132(5):1591-8
pubmed: 17890471
Popul Health Metr. 2014 Mar 21;12(1):8
pubmed: 24656134
BMC Res Notes. 2019 Sep 18;12(1):589
pubmed: 31533804
Front Public Health. 2021 May 21;9:644536
pubmed: 34095053
Antibiotics (Basel). 2021 Mar 08;10(3):
pubmed: 33800406
BMJ Open Respir Res. 2018 Jul 11;5(1):e000276
pubmed: 30018764
BMC Public Health. 2014 Jun 11;14:586
pubmed: 24916459
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003343
pubmed: 17943789
N Engl J Med. 2021 Dec 23;385(26):2441-2450
pubmed: 34936740
Lancet Respir Med. 2022 Jun;10(6):603-622
pubmed: 35338841
JAMA. 1996 Oct 16;276(15):1223-8
pubmed: 8849749
PLoS One. 2016 Oct 5;11(10):e0164172
pubmed: 27706230
JAMA. 2001 Aug 1;286(5):599-603
pubmed: 11476664
Front Pharmacol. 2021 Apr 14;12:659675
pubmed: 33935781
Sci Rep. 2022 Jan 14;12(1):745
pubmed: 35031658