Initiation and Continuation of Antitubercular Therapy during Early COVID-19 Pandemic Period in Sonepat, Haryana, India: A Cross-sectional Study

Abstract

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has halted the progress of India made towards the ambition of achieving Tuberculosis (TB)-free status by 2025. Steps taken to control the disease have affected many national health programs, including those for TB. Aim: To understand the delays in diagnosing and initiating therapy among TB patients receiving Antitubercular Therapy (ATT) during the early COVID-19 pandemic period. Materials and Methods: This was a cross-sectional study conducted in the Sonepat District of Haryana state, India. The study was conducted among 20% of the total Nikshay Portal-notified TB patients who received treatment from the public sector in the second and third quarters of 2020. Data was collected using a pretested semistructured schedule consisting of variables related to demography, past medical history, symptoms leading to TB diagnosis, place of diagnosis, time between symptom onset and diagnosis, duration taken for initiating therapy, and reasons for delays. The Chi-square test and Fisher's exact test were used to test the significance of the differences. A p-value <0.05 was considered significant. Results: ‘Diagnostic Time delay’ was observed among 86 (35.1%) of the participants, with a 30-day median delay. ‘ATT initiation delays’ were observed in 51 (20.8%) with a four-day median delay, and 23 (8.6%) of patients reported at least one episode of treatment interruption. ‘Being diagnosed for other diseases’ 70 (28.6%) and ‘ignoring symptoms’ 28 (11.4%) constituted the major reasons for ‘Diagnostic time delay’. The non availability of drugs 11 (47.8%) and discomfort with drugs 07 (30.4%) were the major reasons for treatment interruption. Conclusion: Ignorance of symptoms and suspicion of other diseases constituted diagnostic delays, and therapy initiations were prolonged more during the pandemic period.

Keywords

• crisis management
• diagnostic delays
• programme functioning
• public health emergency
• public sector
• therapy initiation delays
• tuberculosis