RESUMO
Background: The COVID-19 pandemic has had adverse effects on tuberculosis (TB) management in high-burden countries. We conducted a qualitative study to assess the impact of COVID-19 on Uttarakhand's TB elimination program. Methods: A mixed-methods study was conducted to assess the impact of COVID-19 on the National Tuberculosis Elimination Program (NTEP) in Uttarakhand, India. We collected secondary data through the NIKSHAY portal from April 1, 2019, to March 31, 2021, interviewed program managers for the qualitative part of the study, and documented changes in some of the program core indicators during the study period. Results: The study showed a decrease in TB case notification, an increase in the proportion of missing cases, and a fall in the treatment success rate of new cases during the ongoing COVID-19 pandemic by 17%, 54%, and 45%, respectively. Content analysis of in-depth interviews showed disruption in TB-care services because of COVID-19. Conclusion: TB care services in Uttarakhand have been impacted by measures taken to curb the spread of COVID-19. Both the quantitative and qualitative aspects of the study showed a serious impact on notification rates, diagnostic services, and treatment outcomes for TB patients. In addition, some negative changes have been observed when documenting program indicators (annual case notifications, success rate, treatment success rate) of the National Tuberculosis Elimination Program (NTEP). It is thus predicted that COVID-19 will undermine the Government of India's goal to eradicate TB by 2025 and will negatively affect the TB Program.
RESUMO
Tuberculosis (TB) affects a third of the global population, and a large population of infected individuals still remain undiagnosed-making the visible burden only the tip of the iceberg. The detection of tuberculosis in close-proximity patients is one of the key priorities for attaining the Sustainable Development Goals (SDG) of TB elimination by 2030. With the current battery of screening tests failing to cover this need, the authors of this paper examined a simple and inexpensive point-of-care breath analyzer (TSI-3000(I)), which is based on detecting the volatile organic compounds that are emitted from infected cells and released in exhaled breath as a screening tool for the detection of TB. A single-center pilot study for assessing the diagnostic accuracy of the point-of-care Tuberculosis Breath Analyzer was conducted, and it was compared against the WHO-recommended TrueNat assay, which is a rapid molecular test and was also treated as the reference standard in this study. Of the 334 enrolled participants with TB signs/symptoms, 42.51% were TrueNat positive for Mycobacterium tuberculosis. The sensitivity of the Tuberculosis Breath Analyzer was found to be 95.7%, with a specificity of 91.3% and a ROC area of 0.935. The test kit showed considerable/significant high sensitivity and specificity as reliability indicators. The performance of the Tuberculosis Breath Analyzer tested was found to be comparable in efficiency to that of the TrueNat assay. A large cohort-based multicentric study is feasibly required to further validate and extrapolate the results of the pilot study.