Mitigating the impact of the COVID-19 pandemic on progress towards ending tuberculosis in the WHO South- East Asia Region

Almost half of the deaths worldwide caused by tuberculosis in 2018 occurred in the World HealthOrganization (WHO) South-East Asia Region, home to around a quarter of the global population.Maintaining robust progress in this region is therefore essential if the global goal of ending thetuberculosis epidemic is to be realized. Substantial gains have been made in the region, but the threatto health worldwide posed by the coronavirus disease 2019 (COVID-19) pandemic includes not onlythe direct effects of the pandemic but also the potential eclipsing of the global tuberculosis emergency.The results of modelling studies present stark warnings of a reversal of years of progress and asignificant resurgence in deaths from tuberculosis. The COVID-19 pandemic has had variable impactsin the WHO South-East Asia Region to date, but in the countries most affected there has been targeteddiversion and repurposing of tuberculosis services, health-care workers and diagnostic equipment.The combined effects of COVID-19, containment measures and fragmentation of tuberculosis serviceshave resulted in delays in diagnosis or non-diagnosis and disruption in treatment resulting in increasedmorbidity, mortality, transmission and drug resistance. Countries of the region have made attemptsto ensure continuity of services and civil society and nongovernmental organizations have instituteda range of innovative mechanisms to support national programmes. However, a comprehensiveapproach – including scaling up successful initiatives, empowering community leadership, harnessingdigital tools, and implementing easily accessible cash transfers and nutrition support – will be criticalto success. As COVID-19 recedes, countries will need “catch-up plans” to deploy supplementarymeasures to address the increased tuberculosis burden. Urgent, targeted and agile responses havethe potential to mitigate and reverse the impact of the COVID-19 pandemic on tuberculosis in South-East Asia.

Unravelling India's tobacco epidemic--priorities and recommendations for the second round of Global Adult Tobacco Survey (GATS).

The Global Adult Tobacco Survey, or GATS, has proved to be an invaluable tool for policymakers. In India, it highlighted the alarming rates of prevalence of use and risks both nationally and at state level. However, a rapid analysis of GATS-India shows that there are limitations in methods (sampling, questionnaire, measures undertaken to ensure data quality and management), which may impact the estimates of prevalence. This review discusses these potential weaknesses and recommends measures that can be adopted in the next round of surveys to overcome the limitations.

Assessing compliance to smoke-free legislation: results of a sub-national survey in Himachal Pradesh, India

Introduction: Exposure to second‑hand smoke (SHS) is a serious public healthconcern. The Indian smoke‑free legislation ‘Prohibition of Smoking in Public PlacesRules, 2008’ prohibits smoking in public places, including workplaces.Objective: To measure the status of compliance to legal provisions that protects thepublic against harms of SHS exposure, identifies the potential areas of violationsand informs policy makers for strengthening enforcement measures.Design: A cross‑sectional survey in 1401 public places across 11 district headquartersin Himachal Pradesh, India, using a compliance guide developed by partners ofthe Bloomberg initiatives to reduce tobacco use.Results: In 1401 public places across 11 district headquarters, 42.8% public placeshad signage; in 84.2% public places, no smoking was observed and in 83.7%,there was absence of smoking accessories such as ashtray, matchbox and lighter.Tobacco litter like cigarette butts was absent in 64.7% of the public places. Overall,at the state level, there was more than 80% compliance on at least three of the fiveindicators. Among all categories of public places, educational institutions and officesdemonstrated highest compliance, whereas most frequently visited public places,eateries and accommodation facilities had least compliance.Conclusions: The compliance to ‘Prohibition of Smoking in Public Places Rules,2008’ was variable in various district headquarters of Himachal Pradesh. This studyidentified the potential areas of violations that need attention from enforcementagencies and policymakers

Treatment outcomes of adult patients with recurrent tuberculosis in relation to HIV status in Zimbabwe: a retrospective record review.

BACKGROUND: Zimbabwe is a Southern African country with a high HIV-TB burden and is ranked 19th among the 22 Tuberculosis high burden countries worldwide. Recurrent TB is an important problem for TB control, yet there is limited information about treatment outcomes in relation to HIV status. This study was therefore conducted in Chitungwiza, a high density dormitory town outside the capital city, to determine in adults registered with recurrent TB how treatment outcomes were affected by type of recurrence and HIV status. METHODS: Data were abstracted from the Chitungwiza district TB register for all 225 adult TB patients who had previously been on anti-TB treatment and who were registered as recurrent TB from January to December 2009. The Chi-square and Fischer's exact tests were used to establish associations between categorical variables. Multivariate relative risks for associations between the various TB treatment outcomes and HIV status, type of recurrent TB, sex and age were calculated using Poisson regression with robust error variance. RESULTS: Of 225 registered TB patients with recurrent TB, 159 (71%) were HIV tested, 135 (85%) were HIV-positive and 20 (15%) were known to be on antiretroviral treatment (ART). More females were HIV-tested (75/90, 83%) compared with males (84/135, 62%). There were 103 (46%) with relapse TB, 32 (14%) with treatment after default, and 90 (40%) with "retreatment other" TB. There was one failure patient. HIV-testing and HIV-positivity were similar between patients with different types of TB. Overall, treatment success was 73% with transfer-outs at 14% being the most common adverse outcome. TB treatment outcomes did not differ by HIV status. However those with relapse TB had better treatment success compared to "retreatment other" TB patients, (adjusted RR 0.81; 95% CI 0.68 - 0.97, p = 0.02). CONCLUSIONS: No differences in treatment outcomes by HIV status were established in patients with recurrent TB. Important lessons from this study include increasing HIV testing uptake, a better understanding of what constitutes "retreatment other" TB, improved follow-up of true outcomes in patients who transfer-out and better recording practices related to HIV care and treatment especially for ART.