Continuity of TB services during COVID-19 pandemic
THE current COVID-19 pandemic has been a test for countries, health systems, key stakeholders, and those delivering health services at the front line. When COVID-19 was declared a pandemic, there was concern that TB services in Zimbabwe would be severely affected.
Though service delivery was abruptly disrupted by COVID-19 lockdowns, the Zimbabwe Association of Church-Related Hospitals (ZACH) had to act swiftly to ensure provision of and access to essential TB services.
With support from the U.S. President’s Emergency Plan For AIDS Relief (PEPFAR) through the Centre for Disease Control (CDC) in Zimbabwe, ZACH came up with ways to continue providing health services in a country with strict stay-at-home measures and transport restrictions.
“When COVID-19 struck, we had to think outside the box to maintain TB continuity of care,” said Sihlobo Fuyana, St Luke’s Mission Hospital OI/ART nurse.
Due to disruptions in the provision of and access to TB diagnostic and treatment services due to the COVID-19 pandemic, TB testing and notification rates declined. This has implications on TB mortality among those with delayed diagnosis, increased prevalence as more people with TB are not diagnosed and treated on time.
Caption: OI/ART nurse Sihlobo Fuyana explaining TB regimen to a client at St Luke’s Mission Hospital in Lupane, Matabaleland North province.
TB remains one of the world’s biggest public health threats and now ranks alongside HIV as the world’s leading infectious cause of death. In 2020, there were an estimated 29 000 people diagnosed with TB in Zimbabwe, of whom 2 100 died from the disease in the same year (WHO, 2020). TB is however preventable and treatable and efforts to combat TB must be continuously accelerated.
In COP20, ZACH screened 37 960 ART clients for TB and 230 of those diagnosed with TB and initiated on treatment.
To ensure continuity of TB service delivery in the 75 PEPFAR-supported sites, ZACH scaled up Differentiated Service Delivery (DSD) Models like Community ART-refill groups (CARGS), Family ART-refill groups (FARGS), Outreaches and Adolescent Support Refill Groups based on their unique needs. The outreach initiative, saw testing and medicines dispensing in the community reaching very hard-to-reach areas.
People with impaired immunity, such as people living with HIV, children under five years, and those on certain medications that affect the immune system have a much higher risk of developing TB disease. And the key to TB prevention is reaching people with preventive therapy before the infection develops into an active, infectious disease.
Though still below the Ministry of Health and Child Care recommended 80% of the TB preventative therapy (TPT) coverage ZACH is currently sitting on approximately 75 % TPT coverage. Between April 2020 and March 2021, 11 960 ART clients were screened for eligibility for TPT and by September 2021, 10 139 clients had completed the TPT course.
CDC in Zimbabwe has offered technical assistance to remove bottlenecks in TB/HIV programming to address cross-cutting issues like demand creation, capacity building through training HCWs, supply chain management to ensure uninterrupted testing and medicines and improving data quality. This also includes supporting the rollout of strategies to enhance TB case detection.
“In the face of COVID-19, it has become even more critical to protect the gains achieved to date and ensure continuity of care for ongoing epidemics like TB while keeping the health care workers and the most vulnerable safe. This is a time for resilience, rapid learning, adoptive innovations, and urgent action to save lives,” said Dr. Chidzewere Nzou, ZACH program manager.
“At the forefront of these efforts, we applaud the health care heroes who are tirelessly dedicated to save lives. And we are grateful to CDC in Zimbabwe’s technical assistance in ensuring continued service delivery.”