WHO report raises concern of underreporting due to Covid-19 which can reverse recent progress
Geetanjali Minhas | October 15, 2020 | Mumbai
In India, only 2.40 million out of an estimated 2.64 million cases of tuberculosis were reported to the government, that is, 2,40,000 TB patients went unreported, in 2019, according to the WHO Global Tuberculosis Report 2020.
The reporting of TB cases, however, has significantly increased over the years: from 1.74 million in 2015 to 2.40 million in 2019. Notifications of people newly diagnosed with TB rose from 1.2 million to 2.2 million between 2013 and 2019 (+74%). In 2018 India had an estimated 2.69 million TB patients. The number of laboratory-confirmed multi-drug resistant TB cases has increased from 58,347 in 2018 to 66,255 in 2019.
“As a result, universal drug susceptibility testing, the number of bacteriologically confirmed TB cases tested for rifampicin resistance has increased from 46% in 2018 to 77% in 2019, This is a critical improvement that helps detect drug resistance at the very outset and before initiation of treatment,” says the report released on Wednesday. The incidence per 100,000 population has decreased from 199 in 2018 to 193 in 2019. The total TB incidence rate in India has decreased by almost 50,000 patients over the past one year, it adds.
“It is critical to further reduce the gap and ensure each and every case is notified to the government including from the private sector,” it says.
On TB funding in India, the report says findings say that the national TB budget in 2019 was $497 million of which 85% came from domestic sources and 15% from external and donor agencies. About 77% of the total budget of $583 million came from domestic resources. “This is a significant increase as compared to 2016 numbers when the national TB budget was US$ 280 million and only 38% of it coming from domestic resources.”
Globally, the findings data from 198 countries and territories accounted for more than 99% of the world’s population and estimated number of TB cases. An estimated 10 million people fell ill with TB and estimated 1.4 million died due to TB (including those with HIV) as compared to an estimated 1.5 million deaths in 2018. Out of these, 7.1 million people with TB were reported to have been newly diagnosed and notified in 2019 an increase from 7.0 million in 2018. Approximately 2.9 million TB cases went unreported to national TB programs across the world in 2019. Among all those affected 8.2%were people living with HIV.
“Drug-resistant TB continues to be a public health threat. Worldwide in 2019, close to half a million people developed rifampicin-resistant TB (RR-TB), of which 78% had multidrug-resistant TB (MDR-TB). The three countries with the largest share of the global burden were India (27%), China (14%) and the Russian Federation (8%). 3.3% of new TB cases and 17.7% of previously treated cases had MDR/RR-TB in 2019 globally.”
Covid impact on TB
The Covid-19 pandemic threatens to reverse recent progress in reducing the global burden of TB disease, the report notes. The global number of TB deaths could increase by around 0.2–0.4 million in 2020 alone if health services are disrupted to the extent that the number of people with TB who are detected and treated falls by 25-50% over a period of three months.
India, Indonesia, Philippines and South Africa are the four countries that account for 44% of global TB cases that reported large drops in the reported number of people diagnosed with TB between January and June 2020 as compared with the same six-month period in 2019. Intensified efforts are required to reduce underreporting and improve access to diagnosis and treatment.
The economic impact of the pandemic is predicted to worsen at least two of the key determinants of TB incidence: GDP per capita and under nutrition. “Modelling has suggested that the number of people developing TB could increase by more than 1 million per year in the period 2020-2025. The impact on livelihoods resulting from lost income or unemployment could also increase the percentage of people with TB and their households facing catastrophic costs. In line with WHO guidance, actions that countries have reported taking to mitigate impacts on essential TB services include expanded use of digital technologies for remote advice and support and reducing the need for visits to health facilities by giving preference to home-based treatment and providing TB patients with a one-month supply of drugs,” it says .
“Negative impacts on essential TB services include the reallocation of human, financial and other resources from TB to the Covid-19 response. Many countries have reported the use of GeneXpert machines for COVID-19 testing instead of diagnostic testing for TB, reassignment of staff in national TB programmes to COVID-19 related duties and reallocation of budgets. Smaller but still considerable numbers of countries reported reducing the number of health facilities providing inpatient and outpatient care for people with TB. In many countries, data collection and reporting have also been affected.”
To accelerate and meet global TB targets, the report has recommendations by UN Secretary General that say:
(1) fully activate high-level leadership to urgently reduce TB deaths and drive multisectoral action to end TB
(2) urgently increase funding for essential TB services including for the health workforce
(3) advance universal health coverage to ensure all people with TB have access to affordable quality care and resolve underreporting challenges
(4) address the drug-resistant TB crisis to close persistent gaps in care
(5) scale up provision of TB preventive treatment
(6) promote human rights and combat stigma and discrimination
(7) ensure meaningful engagement of civil society, communities and people affected by TB
(8) substantially increase investments in TB research to drive technological breakthroughs and rapid uptake of innovations
(9) ensure that TB prevention and care are safeguarded in the context of the Covid-19 pandemic and other emerging threats, and
(10) request WHO to continue to provide global leadership for the TB response working in close collaboration with member states and other stakeholders including to preparation for a high-level meeting on TB in 2023.
Read the India TB profile here: https://worldhealthorg.shinyapps.io/tb_profiles/?_inputs_&lan=%22EN%22&iso2=%22IN%22
Read the full report here: https://apps.who.int/iris/bitstream/handle/10665/336069/9789240013131-eng.pdf?ua=1
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