Pune: Diversion of human resources and diagnostic equipment toward Covid19 has had a major impact on the delivery of TB services during the coronavirus pandemic in the past 15 months. Coupled with the fear and stigma around the common symptom of cough among the population, the TB program has witnessed a significant decline in the number of new TB cases being notified to the Maharashtra government.

TB cases
Maharashtra TB cases notifications in last five years

In Maharashtra, TB notifications declined to 10,036 patients in April 2021, compared to an average monthly notification of 19,000 patients during pre-COVID times. Across the country, TB program managers and on-ground officials led the COVID-19 response, owing to their expertise in managing infectious diseases; in addition, TB diagnostic machines, CBNAATs (GeneXpert and Truenat) were used for COVID-19 testing. However, the diversion of human resources and diagnostic equipment toward COVID-19 had a major impact on the delivery of TB services.

“The COVID-19 pandemic and the recent surge in cases posed an unprecedented challenge for the health system in general, and particularly for the TB program. However, despite the monumental challenges faced, Maharashtra’s TB program undertook several pivotal measures to ensure the availability of TB care for all those who needed it.”

Dr Archana Patil
Director, Family Welfare, Directorate of Health Services
Maharashtra

Dr Patil added “Taking cognizance of the impact of COVID-19 on TB services and declining notifications, we developed and quickly deployed several innovative mitigation strategies to proactively ensure continuity of TB services. Interventions such as door-step delivery of drugs to existing patients, partnerships with private laboratories to support TB diagnosis, and community-level engagement, were implemented, Alongside, important policies including bi-directional screening were rolled out to ensure every TB case is detected and notified to the program.”

In line with the guidance from the Government of India to conduct bi-directional screening and testing of COVID-19, TB and influenza-like illness (ILI), and severe acute respiratory infections (SARI) cases, between October 2020 and April 2021, over 4,67,032 patients were screened for TB, of which 5,264 patients were diagnosed for TB, and 96 per cent of them were put on treatment.

“Maharashtra’s TB program has been a front-runner in implementing innovative strategies to control and end TB. Our experience with private sector engagement, community engagement and awareness generation hold us in good stead, as we jointly tackle both TB and COVID-19. With the implementation of important initiatives, we are confident that we will soon bring the program back to pre-COVID levels and ensure we achieve our goal of a TB-free Maharashtra by 2025.”

Dr R S Adkekar
State TB Officer, Maharashtra

The Government of Maharashtra also undertook other critical measures including ensuring regular monitoring and supervision at different levels of governance (from state to sub-district), door-step delivery of drugs to patients, involvement of the private health sector to provide TB care, and active case finding (ACF) drives.

The ACF drive in December 2020, saw over 8 crore people being screened, 3.33 lakh presumptive TB cases being identified, and over 12,823 patients being diagnosed for TB till January 2021. Furthermore, community engagement efforts saw the establishment of District TB Forums in all districts to relay community and patient perspectives to the TB program.

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