Dr. Vladimir John has nearly 10 years in public health, most of which has been in HIV/TB and AIDS services delivery at the clinical and community levels. He has worked as a physician the past six years, and as nursing assistant for more than 6 years. As a Mozambican, he has worked throughout the country, both for international NGOs such as International Organization for Migration (IOM) - UN World Vision International, Population Services International (PSI), Doctors without Borders (MSF), as well as the Ministry of Health at provincial and district levels. Dr. Vladimir will obtain soon a Master degree in Public health and has a Degree in Medicine (M.D.) and a Bachelor of Science (BSc.) in Multidisciplinary Studies of HIV/AIDS & Health from Catholic University of Mozambique.
Impact of COVID-19 on multidrug-resistant tuberculosis treatment care cascade in Beira, Mozambique: a 4-year historical cohort study
Background: Mozambique implemented non-pharmacological measures aiming to contain transmission of the SARS-CoV-2 virus, slow the peak of the epidemic curve, and reduce the burden on health systems. Although these measures were extremely necessary, their impact on multidrug-resistant (MDR) tuberculosis (TB) treatment care cascade (TCC) after four epidemic waves is not well known. We estimated the impact of COVID-19 on the pulmonary MDR-TB TCC in Beira, Mozambique. Methods: A 4-year retrospective study was conducted involving all six TB treatment centers in Beira city. Data from 24 months before COVID-19 and after were extracted from all TB laboratory and treatment registers. Differences in proportions of the TCC indicators were compared between the two periods using the chi-squared test at 5% significance level. Results: 292 MDR-TB cases were diagnosed, of which 47% (138) in the post-COVID-19 period, representing a reduction by 10% from the pre-COVID-19. From 138 MDR-TB, 64% were linked to TB care and initiated treatment, representing a decrease by 24% when compared to pre-Covid-19 era. While monthly follow-up sputum smear examination (FUSSE) is expected during the first 6 months of treatment, the median number (interquartile range - IQR) of documented FUSSE per patient was 2 (1-3) significantly down from 5 (4-6) before Covid-19. The positivity rate of the FUSSE in the post-COVID-19 was almost 3 times higher (>100%) than the pre-COVID-19 period. Notification of TB mortality and treatment success rates declined significantly by 50% and 44%, respectively, while lost to follow-up rate increased significantly by 29%, when compared to the pre-COVID-19 period. Conclusions: The non-pharmacological measures against COVID-19 have significantly impacted on MDRTB case detection, linkage to care, follow-up, and treatment outcomes. There is the need for increased efforts to get the MDR-TB response back on track toward the achievement of global TB targets.