Interruption of tuberculosis detection and care during the Ebola virus disease epidemic (2014–2015) in Liberia: time-series analyses for 2013–2017

Keith L. Gray; Naomi Walker; Frederick Martineau; Nahid Bhadelia; Wahdae mai Harmon-Gray; Laura A. Skrip; Jean DeMarco; Patrick Konwloh; Nelson Dunbar

doi:10.1016/j.ijid.2021.08.041

Interruption of tuberculosis detection and care during the Ebola virus disease epidemic (2014–2015) in Liberia: time-series analyses for 2013–2017

Keith L. Gray, Naomi Walker, Frederick Martineau, Nahid Bhadelia, Wahdae mai Harmon-Gray, Laura A. Skrip, Jean DeMarco, Patrick Konwloh, Nelson Dunbar

Clinical Sciences

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Objective

Interrupted time-series analyses, using 5 years of routinely collected health information system data, were conducted to estimate the magnitude of impact of the 2014–2015 Ebola virus disease (EVD) epidemic and determine trends in tuberculosis (TB) care services in Liberia.

Methods

A segmented linear regression model was used to generate estimates and predictions for trends for three TB service indicators before, during, and after EVD, from January 2013 to December 2017.

Results

It was found that the number of presumptive TB cases declined significantly at the start of the EVD outbreak, with an estimated loss of 3222 cases (95% confidence interval (CI) −5691 to −752; P = 0.014). There was also an estimated loss of 709 cases per quarter post-EVD (95% CI −1346 to −71; P = 0.032). However, over the post-EVD period, quarterly increases were observed in the proportion of smear-positive to presumptive cases (1.45%, 95% CI 0.38% to 2.5%; P = 0.011) and the proportion of treatment success to TB cases evaluated (3.3%, 95% CI 0.82% to 5.79%; P = 0.013).

Conclusions

These findings suggest that the EVD outbreak (2014–2015) negatively affected TB care services. Rigorous quantitative analyses can be used to assess the magnitude of interruption and advocate for preparedness in settings with limited healthcare capacity.

Original language	English
Pages (from-to)	13-20
Number of pages	8
Journal	International Journal of Infectious Diseases
Volume	112
DOIs	https://doi.org/10.1016/j.ijid.2021.08.041
Publication status	Published - 22 Aug 2021

Keywords

Case detection
Delivery of health care
Disease outbreaks
Ebola
Epidemics
Interrupted time-series analysis
Liberia
Mycobacterium tuberculosis
Primary health care
Public health
Treatment outcome
Tuberculosis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ijid.2021.08.041Licence: CC BY-NC-ND

PIIS1201971221006755Final published version, 1.41 MBLicence: CC BY-NC-ND

Cite this

Gray, K. L., Walker, N., Martineau, F., Bhadelia, N., Harmon-Gray, W. M., Skrip, L. A., DeMarco, J., Konwloh, P., & Dunbar, N. (2021). Interruption of tuberculosis detection and care during the Ebola virus disease epidemic (2014–2015) in Liberia: time-series analyses for 2013–2017. International Journal of Infectious Diseases, 112, 13-20. https://doi.org/10.1016/j.ijid.2021.08.041

@article{82806028ff924c5ca20bc1e79fc61e88,

title = "Interruption of tuberculosis detection and care during the Ebola virus disease epidemic (2014–2015) in Liberia: time-series analyses for 2013–2017",

abstract = "ObjectiveInterrupted time-series analyses, using 5 years of routinely collected health information system data, were conducted to estimate the magnitude of impact of the 2014–2015 Ebola virus disease (EVD) epidemic and determine trends in tuberculosis (TB) care services in Liberia.MethodsA segmented linear regression model was used to generate estimates and predictions for trends for three TB service indicators before, during, and after EVD, from January 2013 to December 2017.ResultsIt was found that the number of presumptive TB cases declined significantly at the start of the EVD outbreak, with an estimated loss of 3222 cases (95\% confidence interval (CI) −5691 to −752; P = 0.014). There was also an estimated loss of 709 cases per quarter post-EVD (95\% CI −1346 to −71; P = 0.032). However, over the post-EVD period, quarterly increases were observed in the proportion of smear-positive to presumptive cases (1.45\%, 95\% CI 0.38\% to 2.5\%; P = 0.011) and the proportion of treatment success to TB cases evaluated (3.3\%, 95\% CI 0.82\% to 5.79\%; P = 0.013).ConclusionsThese findings suggest that the EVD outbreak (2014–2015) negatively affected TB care services. Rigorous quantitative analyses can be used to assess the magnitude of interruption and advocate for preparedness in settings with limited healthcare capacity.",

keywords = "Case detection, Delivery of health care, Disease outbreaks, Ebola, Epidemics, Interrupted time-series analysis, Liberia, Mycobacterium tuberculosis, Primary health care, Public health, Treatment outcome, Tuberculosis",

author = "Gray, \{Keith L.\} and Naomi Walker and Frederick Martineau and Nahid Bhadelia and Harmon-Gray, \{Wahdae mai\} and Skrip, \{Laura A.\} and Jean DeMarco and Patrick Konwloh and Nelson Dunbar",

year = "2021",

month = aug,

day = "22",

doi = "10.1016/j.ijid.2021.08.041",

language = "English",

volume = "112",

pages = "13--20",

journal = "International Journal of Infectious Diseases",

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Gray, KL, Walker, N, Martineau, F, Bhadelia, N, Harmon-Gray, WM, Skrip, LA, DeMarco, J, Konwloh, P & Dunbar, N 2021, 'Interruption of tuberculosis detection and care during the Ebola virus disease epidemic (2014–2015) in Liberia: time-series analyses for 2013–2017', International Journal of Infectious Diseases, vol. 112, pp. 13-20. https://doi.org/10.1016/j.ijid.2021.08.041

TY - JOUR

T1 - Interruption of tuberculosis detection and care during the Ebola virus disease epidemic (2014–2015) in Liberia: time-series analyses for 2013–2017

AU - Gray, Keith L.

AU - Walker, Naomi

AU - Martineau, Frederick

AU - Bhadelia, Nahid

AU - Harmon-Gray, Wahdae mai

AU - Skrip, Laura A.

AU - DeMarco, Jean

AU - Konwloh, Patrick

AU - Dunbar, Nelson

PY - 2021/8/22

Y1 - 2021/8/22

N2 - ObjectiveInterrupted time-series analyses, using 5 years of routinely collected health information system data, were conducted to estimate the magnitude of impact of the 2014–2015 Ebola virus disease (EVD) epidemic and determine trends in tuberculosis (TB) care services in Liberia.MethodsA segmented linear regression model was used to generate estimates and predictions for trends for three TB service indicators before, during, and after EVD, from January 2013 to December 2017.ResultsIt was found that the number of presumptive TB cases declined significantly at the start of the EVD outbreak, with an estimated loss of 3222 cases (95% confidence interval (CI) −5691 to −752; P = 0.014). There was also an estimated loss of 709 cases per quarter post-EVD (95% CI −1346 to −71; P = 0.032). However, over the post-EVD period, quarterly increases were observed in the proportion of smear-positive to presumptive cases (1.45%, 95% CI 0.38% to 2.5%; P = 0.011) and the proportion of treatment success to TB cases evaluated (3.3%, 95% CI 0.82% to 5.79%; P = 0.013).ConclusionsThese findings suggest that the EVD outbreak (2014–2015) negatively affected TB care services. Rigorous quantitative analyses can be used to assess the magnitude of interruption and advocate for preparedness in settings with limited healthcare capacity.

AB - ObjectiveInterrupted time-series analyses, using 5 years of routinely collected health information system data, were conducted to estimate the magnitude of impact of the 2014–2015 Ebola virus disease (EVD) epidemic and determine trends in tuberculosis (TB) care services in Liberia.MethodsA segmented linear regression model was used to generate estimates and predictions for trends for three TB service indicators before, during, and after EVD, from January 2013 to December 2017.ResultsIt was found that the number of presumptive TB cases declined significantly at the start of the EVD outbreak, with an estimated loss of 3222 cases (95% confidence interval (CI) −5691 to −752; P = 0.014). There was also an estimated loss of 709 cases per quarter post-EVD (95% CI −1346 to −71; P = 0.032). However, over the post-EVD period, quarterly increases were observed in the proportion of smear-positive to presumptive cases (1.45%, 95% CI 0.38% to 2.5%; P = 0.011) and the proportion of treatment success to TB cases evaluated (3.3%, 95% CI 0.82% to 5.79%; P = 0.013).ConclusionsThese findings suggest that the EVD outbreak (2014–2015) negatively affected TB care services. Rigorous quantitative analyses can be used to assess the magnitude of interruption and advocate for preparedness in settings with limited healthcare capacity.

KW - Case detection

KW - Delivery of health care

KW - Disease outbreaks

KW - Ebola

KW - Epidemics

KW - Interrupted time-series analysis

KW - Liberia

KW - Mycobacterium tuberculosis

KW - Primary health care

KW - Public health

KW - Treatment outcome

KW - Tuberculosis

U2 - 10.1016/j.ijid.2021.08.041

DO - 10.1016/j.ijid.2021.08.041

M3 - Article

SN - 1201-9712

VL - 112

SP - 13

EP - 20

JO - International Journal of Infectious Diseases

JF - International Journal of Infectious Diseases

ER -

Interruption of tuberculosis detection and care during the Ebola virus disease epidemic (2014–2015) in Liberia: time-series analyses for 2013–2017

Abstract

Keywords

UN SDGs

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