Private sector care-seeking pathways and delays in TB care in India, Indonesia and Nigeria in times of COVID-19
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University of Waterloo, Canada
McGill University, Canada
McGIll University, Canada
McGill International TB Centre, Canada
Department of Epidemiology and Biostatistics, Universitas Padjadjaran, Indonesia
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A250
India, Indonesia, and Nigeria have the 1st, 3rd, and 6th highest burden of TB globally. Combined, they accounted for 44% of new cases and 50% of deaths from TB globally in 2021. In these countries, a majority (71% on average) of initial TB care-seeking are with private providers, yet private providers accounted for only 15-31% of TB notifications. The WHO reported that there are 1.8M (or 43% of global total) people with TB that are were not diagnosed in these countries. Reports also show that COVID-19 pandemic has reversed years of progress in the TB response due to control measures and overwhelmed healthcare systems. Our study in these 3 countries show how care-seeking pathways for TB care has changed in 2021, and what implications these changes have for health system recovery post-pandemic. We used cross-sectional surveys with 529 patients in India (n=200), Indonesia (n=149) and Nigeria (n=180) to find onset of symptoms, care-seeking pathway, TB diagnosis and treatment initiation, healthcare use during COVID-19, and the impact of COVID-19 on their care. The results showed significant increases in care-seeking delays, and in numbers of encounters with public and private sector providers. Our study highlights the need to strengthen public-private partnerships, equip the private sector with more access to TB testing tools, implement effective bidirectional screenings for TB and COVID and increasee training for private providers on TB detection.