The study, which offers a comprehensive, nationwide analysis of the intertwined COVID-19 and TB epidemics in Indonesia, found that during the COVID-19 pandemic, the TB case notification rates declined by a staggering 26%, and the treatment coverage declined by 11%. However, there was no significant increase in all-cause mortality, compared to the pre-pandemic period.
The impacts on the national TB control programme were most profound in districts with the highest COVID-19 incidence and the lowest health care resources, particularly in terms of TB diagnostic capacity, and numbers of doctors and primary health centres – the principal setting for the management of both TB and COVID-19 cases.
This research provides valuable insights for policymakers and health practitioners working to mitigate the impact of the two epidemics, and guide further structural investments in health system preparedness, and providing access to quality healthcare services, towards local health systems that are resilient to shocks like COVID-19.
Dr Henry Surendra, Epidemiologist at the Oxford University Clinical Research Unit Indonesia and Associate Professor at Monash University, Indonesia, lead author of the study, said: “One of the key strengths of this study is the use of complete nationwide TB and COVID-19 surveillance data at the district-level, coupled with indicators of human development and health system capacity, for all 514 administrative districts and 34 provinces where over 275 million people reside. The findings highlight that the greatest needs for improving health system resilience exist in the most vulnerable and fragile districts.”
Dr Raph Hamers, Head of the Clinical Infectious Disease Programme at the Oxford University Clinical Research Unit Indonesia, the senior author, added: “Several complex factors in the Indonesian context may have exacerbated the COVID-19 pandemic’s impact on TB case finding and treatment services, including high rates of COVID-19 infections and deaths among frontline healthcare workers, changes in patient health-seeking behavior and temporary restrictions in access to essential health services, as well as a shared dysregulation of immune responses between both pathogens.”
Dr Tiffany Pakasi, Head of TB Working Group at the Ministry of Health Republic of Indonesia, and one of the co-authors of the study, said: “This research highlights the importance of rigorous large-scale, sub-national analyses of patient databases in high-burden TB countries to better understand the direct implications of the COVID-19 pandemic on national TB control programmes.”
Prof. Dr. Ari Fahrial Syam, Dean of the Faculty of Medicine Universitas Indonesia (FMUI) said: “This important work helps us understand the collateral damage from the COVID-19 pandemic on the broader health system in Indonesia. It provides us with insights that reach beyond TB—how and where to make investments in improving the availability of GeneXpert, primary health centers, and doctors across the country. FMUI is committed to its leading role in translational, clinical and diagnostic research, and its National Referral Laboratory for molecular TB testing in the FMUI Department of Clinical Microbiology.”
Dr. Erlina Burhan, TB expert at FMUI, Chair of the COVID-19 Task Force of the Indonesian Doctors Association and Chair of the Professional Organization Coalition Against TB Indonesia, said: “The lessons we have learned from COVID-19, including collaboration, innovation, intervention and implementation, can be directly applied to TB control. The abundant TB data available now can be utilized to enhance evidence-based interventions for TB management and control in Indonesia, moving towards TB elimination by 2030.”
The study, entitled “Impact of the COVID-19 Pandemic on Tuberculosis Control in Indonesia: A Nationwide Longitudinal Analysis of Programme Data”, was conducted by researchers from the Oxford University Clinical Research Unit (OUCRU) Indonesia at the Faculty of Medicine Universitas Indonesia, in collaboration with the Sub-Directorate of Tuberculosis of the Ministry of Health Republic of Indonesia, Monash University Indonesia, and Radboud University Medical Center Netherlands.