Interrupted time-series analysis of active case-finding for tuberculosis during the COVID-19 pandemic, Zambia.
Interrupted time-series analysis of active case-finding for tuberculosis during the COVID-19 pandemic, Zambia.
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DOI：
10.2471/blt.21.286109
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发表时间：
2022-03-01
影响因子：
11.1
通讯作者：
Malama K
中科院分区：
文献类型：
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作者：
Lungu PS;Kerkhoff AD;Muyoyeta M;Kasapo CC;Nyangu S;Kagujje M;Chimzizi R;Nyimbili S;Khunga M;Kasese-Chanda N;Musonda V;Tambatamba B;Kombe CM;Sakulanda C;Sampa K;Silumesii A;Malama K
评估2019冠状病毒病（COVID-19）大流行以及随后实施的结核病应对措施对赞比亚结核病通报的影响。我们使用中断时间序列设计来比较赞比亚在大流行之前（2019年1月至2020年2月）、在实施国家大流行缓解措施之后（2020年4月至2020年6月）和在采取应对措施改善结核病检测之后（2020年8月至2021年9月）的每月结核病通报情况。结核病应对措施包括加强数据监测、基于设施的主动病例发现和产生服务需求的活动。我们使用全国汇总的设施级结核病通报数据进行分析。大流行前结核病病例通报从2019年1月的2890例稳步上升至2020年2月的3337例。在大流行开始并采取缓解措施后，2020年4月的通报数量立即下降了22%（95%置信区间，CI: - 24至- 19）。与艾滋病毒阴性个体相比，人类免疫缺陷病毒（HIV）阳性个体的通报率立即下降幅度更大（- 36%；95% CI: - 38至- 35；- 12%；95% CI: - 17至- 6）。在2020年7月推出结核病应对措施后，全国以及所有亚组和省份的通报率立即增加了45%（95%置信区间：38至51）。到2021年9月，通报的趋势保持稳定，与未发生大流行时的预测数字相似。实施协调一致的公共卫生应对措施，包括主动发现结核病病例，与扭转该流行病的不利影响和采取缓解措施有关。在随后的大流行浪潮中，这些成果得以保持。
To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and the subsequent implementation of tuberculosis response measures on tuberculosis notifications in Zambia. We used an interrupted time-series design to compare monthly tuberculosis notifications in Zambia before the pandemic (January 2019 to February 2020), after implementation of national pandemic mitigation measures (April 2020 to June 2020) and after response measures to improve tuberculosis detection (August 2020 to September 2021). The tuberculosis response included enhanced data surveillance, facility-based active case-finding and activities to generate demand for services. We used nationally aggregated, facility-level tuberculosis notification data for the analysis. Pre-pandemic tuberculosis case notifications rose steadily from 2890 in January 2019 to 3337 in February 2020. After the start of the pandemic and mitigation measures, there was a −22% (95% confidence interval, CI: −24 to −19) immediate decline in notifications in April 2020. Larger immediate declines in notifications were seen among human immunodeficiency virus (HIV)-positive compared with HIV-negative individuals (−36%; 95% CI: −38 to −35; versus −12%; 95% CI: −17 to −6). Following roll-out of tuberculosis response measures in July 2020, notifications immediately increased by 45% (95% CI: 38 to 51) nationally and across all subgroups and provinces. The trend in notifications remained stable through September 2021, with similar numbers to the predicted number had the pandemic not occurred. Implementation of a coordinated public health response including active tuberculosis case-finding was associated with reversal of the adverse impact of the pandemic and mitigation measures. The gains were sustained throughout subsequent waves of the pandemic.