Decline in Prevalence of Tuberculosis After an Intensive Case Finding Campaign and the COVID-19 Pandemic in an Urban Ugandan Community
TAKE-HOME MESSAGE
- Two population-wide tuberculosis (TB) screening campaigns were performed before and after the first year of the COVID-19 pandemic in a Ugandan community with a high burden of TB. The prevalence of TB was noted to be lower after the pandemic. The authors note the variables that might have had an effect on these results, such as social distancing, decreased access to TB care, and increased use of concurrent HIV medications. It is possible that the net effect of the pandemic was the decreased TB burden in this patient population and as a result of the first screening campaign.
- This study effectively characterizes the factors that have played a role in decreasing TB burden in a community, which is important from a global health perspective. It is also important to note the trends in how the pandemic shifted other disease processes.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Systematic screening is a potential tool for reducing the prevalence of tuberculosis (TB) and counteracting COVID-19-related disruptions in care. Repeated community-wide screening can also measure changes in the prevalence of TB over time.
METHODS
We conducted serial, cross-sectional TB case finding campaigns in one community in Kampala, Uganda, in 2019 and 2021. Both campaigns sought sputum for TB testing (Xpert MTB/RIF Ultra) from all adolescents and adults. We estimated the prevalence of TB among screening participants in each campaign and compared characteristics of people with TB across campaigns. We simultaneously enrolled and characterised community residents who were diagnosed with TB through routine care and assessed trends in facility-based diagnosis.
RESULTS
We successfully screened 12 033 community residents (35% of the estimated adult/adolescent population) in 2019 and 11 595 (33%) in 2021. In 2019, 0.94% (95% CI: 0.77% to 1.13%) of participants tested Xpert positive (including trace). This proportion fell to 0.52% (95% CI: 0.40% to 0.67%) in 2021; the prevalence ratio was 0.55 (95% CI: 0.40 to 0.75)). There was no change in the age (median 26 vs 26), sex (56% vs 59% female) or prevalence of chronic cough (49% vs 54%) among those testing positive. By contrast, the rate of routine facility-based diagnosis remained steady in the 8 months before each campaign (210 (95% CI: 155 to 279) vs 240 (95% CI: 181 to 312) per 100 000 per year).
CONCLUSIONS
Following an intensive initial case finding campaign in an urban Ugandan community in 2019, the burden of prevalent TB as measured by systematic screening had decreased by 45% in 2021, despite the intervening COVID-19 pandemic.
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Additional Info
Decline in prevalence of tuberculosis following an intensive case finding campaign and the COVID-19 pandemic in an urban Ugandan community
Thorax 2024 Mar 15;79(4)325-331, EA Kendall, PJ Kitonsa, A Nalutaaya, KO Robsky, KC Erisa, J Mukiibi, A Cattamanchi, M Kato-Maeda, A Katamba, D DowdyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.