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The COVID-19 Impact on Tuberculosis Incidence Notification in India- A Comparative Study (2017-2022)

Piyush Kumar*, Anupama, Alok, Harshika Singh, Priyanka Verma, Abhishek Kumar Sinha

Despite modern drugs treatment with 60 years of chemotherapy and 90 years of vaccination with various strategies to prevent and control Tuberculosis (TB), globally TB ranks 13^th in leading causes of mortality. In recent year 2021 Worldwide, TB ranks 2^nd after COVID-19, in leading causes of infectious killer, killing about 1.6 million people in 2021 (including 187000 people infected with HIV). During COVID-19 era 2020, very significant global reduction in TB incidence was detected, which suddenly reduced from 7.1 million in 2019, to 5.8 million in 2020 (-18%). Globally, India is listed among the top three countries accounting for 67% of this global reduction in TB incidence, besides Indonesia and the Philippines. As per data of The World Bank, India’s annual TB incidence was falling continuously since 2000, rose again and reached 210/100,000 in 2021 from 204/100,000 in 2020. A modelling analysis study found that lockdown has induced 80% reduction in TB notification rates in India. India ranks fourth in infection and death from COVID-19; hence there is a possibility that slowing down of COVID-19 will unmask the TB cases and deaths leading to increase in the count of TB in future years. In spite of several similarities in manifestation and differences in aetiology, there is still lack of full knowledge about the epidemiological relationship between TB and COVID-19 .To know the real situation and scenario of TB cases this study was started with aim to alert policy maker for needful action to control TB effectively in time. This study aimed to know the impact of COVID-19 on annual TB notifications incidence in India. This is a cross-sectional, quantitative, retrospective, deductive study. This research study included all the 36 states and UTs of India. We performed a linear regression study of the existing data of pre pandemic years included in this study for calculating a counterfactual analysis in order to find out the possible real incidence of TB cases notifications, which may have been notified if the current natural intervention of COVID-19 had not taken place. The annual number of new (TB) cases detected during the pre-COVID-19 period as well as COVID-19 period of this study has shown similar trends separately. During both periods the number of new (TB) cases increased in consecutive years. Another significant finding of this study is that the number of new (TB) cases detected during the first two COVID-19 years i.e., 2020 and 2021 decreased in comparison to last pre-COVID-19 year i.e., 2019. The base year of this study i.e., 2017 are having least whereas the last year of this study i.e., 2022 are having the largest number of new (TB) cases detected in one individual year. There is an increase of 7.79% in TB case detection during the COVID-19 period of this study. This study revealed that during first COVID-19 year i.e., 2020 there is significant reduction in number of new (TB) cases detected by 580869 numbers or 24.29% in comparison to last pre-COVID-19 year i.e., 2019. The number of new (TB) cases detected increased continuously during pre-COVID-19 years by 29.59% in 2018 and 18.49% in 2019. The question arises from this study is that, is it possible to achieve the goal of NTEP by year 2025 in current scenario reality?