We call on all governments to ensure continuity of services for people affected by TB with no interruption and no impact on quality
08 April 2020, Geneva, Switzerland - Stop TB Partnership Secretariat organized a rapid assessment of the impact the  COVID19 pandemic and related measures have on the TB response in 20 High Burden Countries that represent 54% of the global TB burden, through interviews with National TB Programmes (NTPs) and focal points based on a set of open-ended questions. Similarly, the Global Coalition of TB Activists (GCTA) did a worldwide survey through their network of members collecting answers from TB civil society and communities from 16 countries, with data updated regularly.

The results of these assessments indicate that the measures taken for the COVID-19 pandemic produce significant disruptions in the TB Programmes and the TB response and have a massive impact on communities and people affected by TB, and especially among the most vulnerable who are struggling to get their treatment, care and other types of support.
Therefore, Stop TB Partnership and partners call on all governments and stakeholders to ensure that the TB Progammes and operations continue, without interruption and to ensure that the measures taken to fight COVID-19 are not having a negative impact on the provision of diagnosis, treatment, care and other types of support to people affected by TB, including most vulnerable groups.

Main findings of the NTP rapid assessment are:
  • All NTPs reported that they are engaged in the COVID-19 response - NTPs and other senior staff are personally involved at coordination level and other TB staff is engaged to a varying degree in all types of COVID-19 responses. At least 40% of NTPs reported that TB facilities (hospitals, dispensaries) are being used for the COVID-19 response; all NTPs mentioned that the national COVID-19 response plans envisage that TB facilities will be fully utilized if COVID-19 gets more widespread.
  • NTPs underlined that they are doing their best to ensure that TB Programme management is not affected but conditions are becoming very difficult.
  • All NTPs mentioned that they observe a decrease in the number of people presenting/accessing services for TB. In India, there is approximately an 80% decline in daily TB notifications during the lockdown period compared to the average daily notifications; the only country we had real-time data to analyze. Lack of real-time data makes it difficult even for national authorities to assess the situation in terms of decrease in case notifications and access. Other situations observed are:
    • People avoid going to or have no possibilities to reach hospitals and medical clinics due to lockdown and  reduced transportation means. 
    • Disruptions in sputum transportation and on providing different types of treatment support. 
    • Active TB Case Finding (ACF) activities have stopped.
    • TB Programmes did not have time to be prepared for the use of digital technology to monitor treatment adherence. 
    • Disruption on diagnosis activities, due to lack of staff and sometimes even laboratory space.
  • Disruption of planned activities, including activities included in the Global Fund grants, due to restrictions, lockdown and curfew - training, supervision, reaching vulnerable groups - including migrants, development and endorsement of National Strategic Plans and development of next funding requests.
  • Enrollments and work in large TB research studies have stopped.
  • No NTP expressed significant disruption on commodities and supplies. However, two NTPs are worried about future availability of some products. The challenges they see related to uninterrupted quality-assured TB commodities are linked to:
    • Domestic funding constraints for TB commodities procurement while allocating all available resources combating COVID-19. 
    • Disrupted importation processes of goods. 
    • In-country transportation, distribution and warehousing limitations. 
    • Non-preparedness of TB Programmes to switch to different models of Observed Therapy.

All NTPs shared that they are worried because of the vulnerability of people with TB and drug-resistant TB to COVID-19 and more aggravated COVID-19 forms with anticipated higher TB mortality; significant concerns on management of drug-resistant TB as hospitals are severely affected or moved to COVID-19 response; lack of Personal Protective Equipment for health care providers who are demoralized, with huge workload; as well as concerns to align with the ongoing and planned health system reforms (including changes in financing systems).

The survey carried out by the Global Coalition of TB Activists (GCTA) through communities, civil society and people affected by TB found severe, and similar impact of the COVID-19 situation on TB response and people with TB.

  • Lack of access to testing due to no access to public transport to reach facilities, fear of COVID-19 due to lack of any individual protective measures, lab staff too busy with COVID-19 testing.
  • Lack of medicines by patients under treatment due to mandatory curfew with no time to prepare in advance, lack of transportation means and no public transport, public hospitals in stock out.
  • Interruption of nutritional support.
  • People with TB are struggling to procure food as most of them are daily wage workers and buy food every day.
  • False information being circulated in communities.

Countries assessed and surveyed are: Afghanistan, Bangladesh, Cambodia, Cameroon, Côte d'Ivoire, India, Indonesia, Kazakhstan, Kenya, Moldova, Mozambique, Nepal, Nigeria, Peru, Philippines, South Africa, Tajikistan, Thailand, Turkmenistan, Uganda, Ukraine, Uzbekistan, Vietnam, Zambia and Zimbabwe.