Country success stories in implementing innovative TB responses to the COVID 19 pandemic

The COVID-19 pandemic has adversely affected essential tuberculosis (TB) services in many countries. This is most evident in the sharp fall in the global number of people with TB who were diagnosed and reported to national authorities between 2019 and 2020 (-19%, from 7.1 million to 5.8 million), with even larger reductions in several high TB burden countries (Section 1, Section 3.1). There have also been reversals in the provision of TB preventive treatment (Section 4), spending on TB services and coverage of bacille Calmette-Guérin (BCG) vaccination (Section 5) (1).

Countries have implemented a variety of approaches to mitigate the impact of the pandemic on essential TB services. Major examples documented by the World Health Organization (WHO) in the Global tuberculosis report 2020, based on data reported by 184 countries, included reductions in the required frequency of outpatient visits for treatment monitoring or collection of drugs, allowing TB patients to take home a 1-month or more supply of anti-TB drugs, allowing TB patients to nominate another household member to collect anti-TB drugs on their behalf, and expanded use of remote advice and support (2).

To support countries to effectively respond to disruptions to essential TB services due to COVID-19, in late 2020, WHO launched a call for case studies of innovative responses that had succeeded in mitigating or reversing negative impacts. The aim was to compile, document and disseminate examples of best practices, and associated new knowledge and lessons learned. A first report comprising 23 case studies from all six WHO regions was issued in May 2021 (3).

More than half of the 23 case studies described the successful implementation of digital interventions, including for telemedicine, video-supported treatment, TB surveillance and programmatic monitoring (Table 1). This is consistent with data previously reported to WHO in 2020 (2) and from other surveys (4). The report also provides examples of how public-private sector alliances and enhanced community engagement are being forged or strengthened. The case studies also show how TB-related actions have contributed to COVID-19 management (e.g. the use of rapid molecular diagnostic platforms for diagnosis of both diseases, use of existing decentralized service provision structures and patient education platforms for TB to support the COVID-19 response, and drawing on TB-related experience in how to address vulnerabilities). Summaries of a selection of the 23 case studies are provided in (Box 1).

The case studies show that, in the face of a crisis, countries have expanded the use of newer tests and treatments as well as digital technologies, some of which have been recommended for a long time. The TB community at all levels needs to sustain and build on this progress.

Publication of the case studies by WHO in May 2021 was done in time for the studies to inform applications to the COVID-19 Response Mechanism (C19-RM) of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was created to mitigate the pandemic’s impact on HIV, TB and malaria. The website of the WHO Global TB Programme also includes a compendium of resources on TB and COVID-19 (5), including research projects and an inventory of peer-reviewed or preprint manuscripts. WHO plans to publish an updated report, with additional country case studies, before the end of 2021.

Table 1 Thematic profiles of the 23 case studies from the 2021 WHO report on innovative TB responses to the disruptions caused by the COVID-19 pandemic