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Notes from the Field: Effects of the COVID-19 Response on Tuberculosis Prevention and Control Efforts – United States, March-April 2020

Our take —

This study assessed the impact of COVID-19 on US state, local, and territorial TB programs. The COVID-19 response impacted essential preventive and clinical care for other conditions, of which TB is an example. During the COVID-19 response, there are likely to be a host of unfulfilled essential public health services for many conditions which should be addressed to prevent retrogression in public health gains.

Study design

Cross-Sectional

Study population and setting

This aim of this study was to examine the impact of COVID-19 deployments (i.e., re-assignment of personnel time to COVID-19 response) on essential tuberculosis (TB) activities. The respondents in this study were US state, local, and territorial TB programs (grantees) funded through the TB Elimination and Laboratory cooperative agreement by CDC. These programs report data to CDC to enable measurement of performance of essential TB program activities, and progress toward TB elimination. Following the first US COVID-19 case in January 2020, grantees informed CDC project managers that personnel, including some focused on TB would be assigned to COVID-19 response. To evaluate the effect of COVID-19 deployments on essential TB activities, CDC project officers communicated with grantees in April 2020. Effects of COVID-19 deployments on essential TB activities were classified into: 1) None (i.e., no impact/changes to staffing assignments or TB program activities); 2) Partial (i.e., <50% of personnel time dedicated to COVID-19 response or some changes made to programs, but TB activities still being performed); 3) High (i.e., 50-100% of personnel time dedicated to COVID response, major changes made to program activity, or activity not being performed).

Summary of Main Findings

In total, 50 out of 61 (82%) grantees were reached. Among these 50, the proportion of programs reporting partial/high impact on staffing capacity were as follows: administration and fiscal management (62%), clinical consultation or clinic service delivery (66%), outreach and field services (60%), surveillance and case reporting (72%), and training and program evaluation (68%). In addition, proportion of grantees reporting partial/high impact on indicators of TB control were as follows: diagnosis and treatment of persons with TB disease (52%) and latent TB infection (68%), contact investigations for infectious TB cases (64%), targeted testing and treatment of latent TB infection among at-risk populations (74%), and case reporting and surveillance activities (58%). More than 90% of respondents in the March and April webinars for National TB Controllers Association (which represents all state, local, and territorial TB programs) noted that their TB programs had assigned personnel to COVID-19 response.

Study Strengths

The authors were able to contact a high percentage (82%) of the 61 state, local, and territorial TB programs funded through the TB Elimination and Laboratory cooperative agreement.

Limitations

It is possible that the organizations that were not reached could differ in significant ways from those that were reached. For example, if the unreached organizations were more likely to experience partial/high impact than the organizations that were reached, then the effects reported in this study would be underestimates.

Value added

This study describes the impact of the COVID-19 response on essential TB elimination activities such as screening, diagnosis and treatment in the first wave of the COVID-19 pandemic in the US.

This review was posted on: 20 August 2020