A research undertaken by The George Institute for Global Health, India, has found that the restrictions imposed to combat the COVID-19 pandemic has exacerbated the country's tuberculosis (TB) problems. As per the findings of the research, up to 7% of identified TB patients in India had stopped consuming TB medications during the lockdown. The research paper, titled ‘Impact of COVID-19 restrictive measures on income and health service utilisation of tuberculosis patients in India’, was published in BMC (BioMed Central) Infectious Diseases earlier this year.
The paper took note of the fact that there was approximately an 80% decline in daily TB notifications during the nationwide lockdown period (from the end of March 2020 to June 2020) compared to average daily notifications, and proceeds to dig into the reason behind this. “Explanations of this decline included the following: GeneXpert machines and other laboratory facilities/space were switched for use for COVID-19 response, reduced availability of health care staff generally or because they were too busy with COVID-19 testing, lack of access to health facilities due to no access to public transport, and fear of getting infected with COVID-19,” it said.
However, based on the study undertaken among 291 persons (89 from the general population and 202 from tea garden areas) suffering from TB, researchers also found that there was widespread discontinuation of medicines. They also noticed that at least 4-7% of patients were compelled to discontinue their medicines during the nationwide lockdown. “Approximately 7% of patients in the general population and 4% in tea garden areas discontinued their tuberculosis medicines because of the complete lockdown,” the study said, adding that apart from this, three patients had completely stopped TB medicine during this period.
“Patients were finding it difficult to continue TB treatment because the government health facilities were focused on the pandemic. Also, they could not travel due to travel restrictions,” said Palash Das, Research Fellow, The George Institute for Global Health, India.
Speaking about the consequences of the discontinuation of medicines, the paper said that it will have an additional burden on the country’s TB programme, “with additional TB cases and maybe multidrug-resistant TB cases”. According to the Centers for Disease Control and Prevention (CDC), multidrug-resistant TB is caused when the bacteria becomes resistant to the medicines treating TB, which makes it impossible to kill the bacteria.
The research paper also pointed out the link between income loss and its impact on the nutrition of individuals, further stating that there is a “bidirectional relationship between undernutrition and TB”. Researchers had also identified that between 24-42% of patients did not receive the benefit under the Nikshay Poshan Yojana — which is supposed to provide nutritional support to all registered TB patients by transferring the benefit directly to the beneficiaries’ bank accounts — in April 2018.
The paper added that TB patients working in the informal sector were the worst affected group during the nationwide lockdown, emphasising on the need for a policy priority to protect those working in informal sectors from the economic consequences of restrictive measures such as lockdowns. “Alongside ensuring widespread access to COVID-19 vaccines, these policy actions remain pivotal in ensuring the well-being of those who are unfortunate enough to be living with tuberculosis,” it said.
The findings were made by researchers Dr Susmita Chatterjee, Palash Das, and Dr Anna Vassall, as part of an ongoing cohort study aimed at examining the economic burden on TB patients in India.