The COVID-19 pandemic has created many barriers to tuberculosis (TB) treatment and care. In Burkina Faso, a recent study supported by TDR and partners found that the average length of time between the onset of TB symptoms and the first consultation with a health service had increased by 73%, compared with data from 2017/2018. 

These findings highlight just one of the ways in which the COVID-19 pandemic is threatening progress on reducing the global burden of TB. In fact, 12 months of COVID-19 has eliminated 12 years of progress in fighting TB, according to the Stop TB Partnership. Ensuring continuity of TB services and essential operations as well as developing or adapting existing strategies is critical to protect the lives of people with TB during this pandemic. 

In April 2020, TDR, in partnership with the Access and Delivery Partnership Project (ADP), Damien Foundation, the WHO Global TB Programme and The Union, launched an initiative to help countries in West and Central Africa evaluate new and adapted strategies to mitigate the impact of COVID-19 on TB care and control through implementation research.

Leveraging the research expertise in the West and Central African Research Networks for TB control (WARN/CARN-TB), 11 projects were competitively selected and are described below.

In Cameroon, Chad, Côte d’Ivoire, Niger and Togo, National TB programmes and researchers are evaluating the effectiveness of community-based TB treatments, compared with care delivered by health facilities. And in Benin, Niger and Senegal, novel tools such as teleconsultations and e-technology for programme monitoring and training are being studied as ways of mitigating the impact of the pandemic on TB care services. In Guinea and Niger, the COVID-19 pandemic is being used as an opportunity to expand TB screening to patients suspected of being infected with COVID-19. 

“These studies demonstrate the variety of new strategies being tested to overcome challenges to TB control during the COVID-19 pandemic,” said John Reeder, Director of TDR. “The challenges are creating opportunities for innovation to ensure the continuity of TB services.” 

Evaluating digital technologies for TB care and supporting safety monitoring

The COVID-19 pandemic has highlighted the need to ensure ongoing treatment and care for TB patients at a time when contact between patients and providers is reduced due to, for example, disrupted TB services, social distancing or lockdown measures. Digital technologies can help circumvent such challenges and help maintain service continuity by providing virtual care and support to patients and TB programmes. 

The IR toolkit to inform the implementation and scale up of digital technologies for TB (IR4DTB), developed in partnership with WHO’s Global TB Programme, aims to generate new evidence to bridge the knowledge gaps on an optimal application of digital health technologies specific to TB work and inform future WHO guidance on their use. This tool is an adaptation of the IR Toolkit developed by TDR in 2014 and contains six modules designed to guide users through the key IR steps, resulting in the development of a comprehensive IR proposal. 

Additionally, in line with the WHO GTB recommendation for reducing patient-provider contacts during the pandemic and enhancing the use of all oral shorter treatment for multidrug- and rifampicin-resistant TB (MDR/RR-TB) and extensively drug-resistant TB (XDR-TB), TDR is coordinating the ShORRT initiative. This is being conducted in close collaboration with the Global TB Programmes and aims to facilitate studies on oral, shorter and safer regimens of varied composition by countries, and to generate data on harmonized methodology across different settings. 

This research will help guide the course of novel drug regimens and generate evidence for policy change. Launched in November 2019, the ShORRT initiative is now involving and supporting 25 countries worldwide, working alongside WHO regional and country offices, academia, technical partners such as KNCV Tuberculosis Foundation, the Union and Damien Foundation, and funding agencies such as the United States Agency for International Development (USAID) and The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Despite the challenges posed by the current COVID-19 pandemic, research teams in countries such as Nigeria, Cambodia and Pakistan have established their study protocols and started recruiting patients.

If countries are using new TB drugs as facilitated by the ShORRT initiative, this needs to be done while ensuring the safety of the patients. In partnership with the Access and Delivery Partnership (ADP), TDR is also supporting West and Central African countries in their efforts to improve safety monitoring of TB patients. Findings from a recent survey revealed that among the 27 countries of WARN-TB and CARN-TB, only 14 NTPs have started implementing active TB drug safety monitoring and management. The remaining countries are currently developing implementation plans by the end of this year.

For more information, please contact Dr Corinne Merle.

This article was originally published in