{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T23:21:43Z","timestamp":1793402503177,"version":"4.5.0"},"reference-count":24,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI069907"],"award-info":[{"award-number":["U01AI069907"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI069911"],"award-info":[{"award-number":["U01AI069911"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI069918"],"award-info":[{"award-number":["U01AI069918"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI069919"],"award-info":[{"award-number":["U01AI069919"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI069924"],"award-info":[{"award-number":["U01AI069924"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI096299"],"award-info":[{"award-number":["U01AI096299"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,2,25]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The COVID-19 pandemic challenged healthcare systems, particularly in settings with high infectious disease burden. We examined the postpandemic long-term impacts of COVID-19 on tuberculosis (TB) services at anti-retroviral therapy (ART) clinics in lower-income countries.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using standardised online questionnaires, we conducted a cross-sectional site survey among ART clinics providing TB services in Africa and Asia from July to September 2023 (site-level information and number of TB diagnoses and tests).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 45 participating ART clinics, 32 (71%) were in Africa and 13 (29%) in Asia. During the COVID-19 pandemic (2020\u20132022), 43 (96%) clinics reported implementing social distancing or separation measures, 39 (87%) personal protections for staff members and 32 (71%) protections for patients. Infection control measures were in place in 45% of the clinics before the pandemic (until 2019), 23% introduced measures during the pandemic and 15% maintained them after the pandemic (after 2022). Service provision was affected during the pandemic in 33 (73%) clinics, including TB services in 22 (49%) clinics. TB service restrictions were addressed by introducing changes in directly observed therapy provision in 8 (18%) clinics, multimonth TB drug dispensing in 23 (51%), telehealth services in 25 (56%) and differentiated service delivery in 19 (42%). These changes were sustained after the pandemic at 4 (9%), 11 (24%), 17 (38%) and 12 (27%) clinics, respectively. Compared with 2018\u20132019, the number of TB diagnoses decreased sharply in 2020\u20132021 and improved after the pandemic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>COVID-19 affected TB care services in ART clinics in Africa and Asia. This was paralleled by a reduction in TB diagnoses, which partly resumed after the pandemic. Infection control measures and alternative modes of service delivery were adopted during the pandemic and only partially maintained. Efforts should be made to sustain the lessons learnt during the COVID-19 pandemic, particularly approaches that reduce the risk of transmission of infectious diseases, including TB, in ART clinics.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-017828","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T23:06:45Z","timestamp":1742857605000},"page":"e017828","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa"],"prefix":"10.1136","volume":"10","author":[{"given":"Marie","family":"Ballif","sequence":"first","affiliation":[{"name":"Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland"},{"name":"Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Banholzer","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Perrig","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anchalee","family":"Avihingsanon","sequence":"additional","affiliation":[{"name":"HIV-NAT \/ Thai Red Cross AIDS Research Centre and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique Mahambu","family":"Nsonde","sequence":"additional","affiliation":[{"name":"Centre de Traitement Ambulatoire, Brazzaville, Republic of Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Obatsa","sequence":"additional","affiliation":[{"name":"Centre for Microbiology and Research, Kenya Medical Research Institute, Kisumu, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Muula","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia, Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Komena","sequence":"additional","affiliation":[{"name":"PAC-CI program, Abidjan, C\u00f4te d\u2019Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Uemura","sequence":"additional","affiliation":[{"name":"AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Lelo","sequence":"additional","affiliation":[{"name":"Pediatric Hospital of Kalembelembe, Kinshasa, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Otaalo","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Huwa","sequence":"additional","affiliation":[{"name":"Lighthouse Trust, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrice","family":"Gou\u00e9ss\u00e9","sequence":"additional","affiliation":[{"name":"CePReF, Abidjan, C\u00f4te d\u2019Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagalingeswaran","family":"Kumarasamy","sequence":"additional","affiliation":[{"name":"CART Clinical Research Site, Voluntary Health Services, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Brazier","sequence":"additional","affiliation":[{"name":"City University of New York, Institute for Implementation Science in Population Health, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denna","family":"Michael","sequence":"additional","affiliation":[{"name":"Kisesa Observation Cohort study, National Institute for Medical Reseach, Mwanza, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idiovino","family":"Rafael","sequence":"additional","affiliation":[{"name":"SolidarMed, Chiure, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Ramd\u00e9","sequence":"additional","affiliation":[{"name":"CHU Sour\u00f4 Sanou, Bobo-Dioulasso, Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I Ketut Agus","family":"Somia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Udayana University, Ngoerah Hospital, Bali, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2110-2631","authenticated-orcid":false,"given":"Marcel","family":"Yotebieng","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lameck","family":"Diero","sequence":"additional","affiliation":[{"name":"Department of Medicine, Moi University, AMPATH Program \/ Moi Teaching and Referral Hospital, Eldoret, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3937-7855","authenticated-orcid":false,"given":"Jonathan","family":"Euvrard","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1595-2506","authenticated-orcid":false,"given":"Oliver","family":"Ezechi","sequence":"additional","affiliation":[{"name":"Centre for Reproduction and Population Health Studies, Nigerian Institute of Medical Research, Lagos, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3309-4835","authenticated-orcid":false,"given":"Lukas","family":"Fenner","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"2025072915001830000_10.3.e017828.1","unstructured":"World Health Organization . Global tuberculosis report 2023. 2023. Available: https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tb-reports\/global-tuberculosis-report-2023 [Accessed 29 Apr 2024]."},{"key":"2025072915001830000_10.3.e017828.2","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/S2213-2600(22)00092-3","article-title":"The intersecting pandemics of tuberculosis and COVID-19: population-level and patient-level impact, clinical presentation, and corrective interventions","volume":"10","author":"Dheda","year":"2022","journal-title":"Lancet Respir Med"},{"key":"2025072915001830000_10.3.e017828.3","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2021-217529"},{"key":"2025072915001830000_10.3.e017828.4","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26036","article-title":"Service delivery challenges in HIV care during the first year of the COVID-19 pandemic: results from a site assessment survey across the global IeDEA consortium","volume":"25","author":"Brazier","year":"2022","journal-title":"J Int AIDS Soc"},{"key":"2025072915001830000_10.3.e017828.5","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2023.1234785","article-title":"The impact of the COVID-19 pandemic on the global tuberculosis epidemic","volume":"14","author":"Falzon","year":"2023","journal-title":"Front Immunol"},{"key":"2025072915001830000_10.3.e017828.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0153243","article-title":"Implementation of Tuberculosis Intensive Case Finding, Isoniazid Preventive Therapy, and Infection Control (\u201cThree I\u2019s\u201d) and HIV-Tuberculosis Service Integration in Lower Income Countries","volume":"11","author":"Charles","year":"2016","journal-title":"PLoS One"},{"key":"2025072915001830000_10.3.e017828.7","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26018","article-title":"Impact of the COVID-19 pandemic on TB services at ART programmes in low- and middle-income countries: a multi-cohort survey","volume":"25","author":"Marti","year":"2022","journal-title":"J Int AIDS Soc"},{"key":"2025072915001830000_10.3.e017828.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2025072915001830000_10.3.e017828.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2025072915001830000_10.3.e017828.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000180","article-title":"Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries","volume":"2","author":"Z\u00fcrcher","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"2025072915001830000_10.3.e017828.11","unstructured":"Flaxman S , Gelman A , Neill D , et al . Fast hierarchical Gaussian processes. 2015."},{"key":"2025072915001830000_10.3.e017828.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003979","article-title":"India\u2019s syndemic of tuberculosis and COVID-19","volume":"5","author":"Shrinivasan","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2025072915001830000_10.3.e017828.13","unstructured":"Migliori GB , Thong PM , Akkerman O , et al . Worldwide effects of coronavirus disease pandemic on tuberculosis services, January\u2013April 2020 - Volume 26, number 11\u2014November 2020 - emerging infectious diseases journal [CDC]. 2020. Available: https:\/\/wwwnc.cdc.gov\/eid\/article\/26\/11\/20-3163_article"},{"key":"2025072915001830000_10.3.e017828.14","doi-asserted-by":"crossref","first-page":"e629","DOI":"10.1016\/S2352-3018(20)30211-3","article-title":"Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models","volume":"7","author":"Jewell","year":"2020","journal-title":"Lancet HIV"},{"key":"2025072915001830000_10.3.e017828.15","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1016\/j.ijid.2021.03.038","article-title":"Minimizing the impact of the triple burden of COVID-19, tuberculosis and HIV on health services in sub-Saharan Africa","volume":"113 Suppl 1","author":"Nachega","year":"2021","journal-title":"Int J Infect Dis"},{"key":"2025072915001830000_10.3.e017828.16","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-020-02871-9"},{"key":"2025072915001830000_10.3.e017828.17","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/S2213-2600(20)30311-8","article-title":"How COVID-19 could benefit tuberculosis and HIV services in South Africa","volume":"8","author":"Keene","year":"2020","journal-title":"Lancet Respir Med"},{"key":"2025072915001830000_10.3.e017828.18","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25704","article-title":"Acceleration of differentiated service delivery for HIV treatment in sub-Saharan Africa during COVID-19","volume":"24","author":"Grimsrud","year":"2021","journal-title":"J Int AIDS Soc"},{"key":"2025072915001830000_10.3.e017828.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002595","article-title":"Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies","volume":"15","author":"Alipanah","year":"2018","journal-title":"PLoS Med"},{"key":"2025072915001830000_10.3.e017828.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003020","article-title":"Personalized public health: An implementation research agenda for the HIV response and beyond","volume":"16","author":"Geng","year":"2019","journal-title":"PLoS Med"},{"key":"2025072915001830000_10.3.e017828.21","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.19.1.21484","article-title":"Reimagining HIV service delivery: the role of differentiated care from prevention to suppression","volume":"19","author":"Grimsrud","year":"2016","journal-title":"J Int AIDS Soc"},{"key":"2025072915001830000_10.3.e017828.22","doi-asserted-by":"crossref","unstructured":"Christ B , van DJ , Ballif M , et al . Differentiated antiretroviral therapy delivery in rural Zimbabwe: availability, needs and challenges [OSF Preprints]. 2020. Available: https:\/\/osf.io\/zpq2e\/","DOI":"10.31219\/osf.io\/zpq2e"},{"key":"2025072915001830000_10.3.e017828.23","doi-asserted-by":"crossref","first-page":"e1257","DOI":"10.1016\/S2214-109X(22)00285-6","article-title":"The COVID-19 pandemic and disruptions to essential health services in Kenya: a retrospective time-series analysis","volume":"10","author":"Kiarie","year":"2022","journal-title":"Lancet Glob Health"},{"key":"2025072915001830000_10.3.e017828.24","doi-asserted-by":"crossref","first-page":"e1132","DOI":"10.1016\/S2214-109X(20)30288-6","article-title":"Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study","volume":"8","author":"Hogan","year":"2020","journal-title":"Lancet Glob Health"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2024-017828","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T22:00:33Z","timestamp":1753826433000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2024-017828"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":24,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,24]]},"published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1136\/bmjgh-2024-017828"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2024-017828","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}