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How the COVID-19 pandemic threatens the fight against tuberculosis in Africa

By our journalist-in-residence Lungelo Ndhlovu.


Image 1/1 : TB laboratory technician using the Xpert machine at Mpilo Central Hospital. Picture by Lungelo Ndhlovu.

Multi-Drug Resistant Tuberculosis (MDR-TB) poses a big problem globally, as efforts to control it have been negatively affected by the COVID-19 pandemic. Clinical experts say the new challenges slow down the gains that have already been made in eliminating the disease in Africa.

MDR-TB is caused by an organism that is resistant to at least two of the most potent TB drugs: isoniazid and rifampicin, according to the Centre for Disease Control and Prevention. Dr. Ngabonziza who works in Rwanda on MDR-TB, confirms that COVID-19 hugely impacted life threatening diseases, including MDR-TB, globally, also acknowledging how in Rwanda the number of Rifampicin-Resistant TB (RR-TB) patients was far lower  than expected in January  2020. “We are still evaluating the real extent of COVID-19 impact on TB care in Rwanda,” he said.

Dr Ngabonziza said, a country using the Xpert MTB/RIF machine could monitor false resistance by repeating the testing and/or using other rifampicin resistance diagnostic tool like Genotype MTBDRplus. “Discordant results between repeated Xpert tests and/or other methods may already be a signal of false results that can then be confirmed by a reference standard method for rifampicin resistance detection.”

A similar observation of the impact of COVID-19 on TB and other health programmes was made in Zimbabwe. Programmatic Management of Drug-Resistant Tuberculosis Officer in the Ministry of Health and Child Care, National TB and Leprosy Control Programme, Dr Tendai Nkomo, agrees that the pandemic has disrupted care-seeking pathways for patients who may have TB. “Challenges such as accessing public transportation during the lockdown reduced the number of patients that visited health facilities. Therefore the number of patients examined for or diagnosed with (MDR-)TB”, he says. Dr Nkomo adds that priority shifting from TB to COVID-19 also results  in missed TB screening opportunities. “Patients with a cough have been screened for COVID-19, but not for TB”, he adds.

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