Resilience strengthening of tuberculosis diagnostic services under national tuberculosis program to withstand pandemic situations

Abstract

In the midst of extraordinary challenges, uncertainty, and the rapidly changing scenario of the prevailing COVID-19 pandemic, existing tuberculosis (TB) laboratories worldwide had to gear up on very short notice to face the dual challenge of fulfilling the increasing demands of laboratory testing for COVID-19 while simultaneously continuing the TB services. The brunt of the same fell on routine TB laboratory services, which include diagnostics (microscopy, rapid molecular testing, culture, and drug-susceptibility testing), and activities of training, quality assurance, and research pertaining to TB worldwide. With the sudden eruption and rapid spread of the global pandemic of COVID-19, TB diagnostic services were affected or disrupted especially where laboratories lacked adequate infrastructure and adequate resources for safe handling of specimens. The human resource challenges such as panic and apprehensions among laboratory workers to deal with newer pathogens, particularly those performing direct smear microscopy, along with staff shortage due to deployment in COVID-19 management duties and the pressure of continuing TB services with enhanced biosafety practices were difficult to handle. We also experienced decline in specimen workload at our national reference laboratory for TB diagnosis by 31% in 2020 as compared to pre-COVID period (2019). This is worrisome as undiagnosed TB as well as improper follow-up of those on TB treatment during the peak of COVID-19 pandemic could be associated with enhanced community transmission of TB and poorer patient outcomes. As the COVID-19 pandemic stretched out untiringly in the country and world over, we rapidly need to adapt and find ways to effectively sustain TB diagnostic services, training and research activities. In this perspective, we document current challenges of TB laboratories and suggest robust ways to address them including biosafety concerns. The safe integration of diagnostic services for TB and where required newer airborne pathogens, to ensure uninterrupted TB services, must be the utmost priority in the face of ongoing and any future unprecedented pandemics.