The influence of the Ebola outbreak on presumptive and active tuberculosis in Bombali District, Sierra Leone

Abstract

Objective: To compare the number of patients with pre- sumptive tuberculosis (TB), the number of patients regis- tered with TB (including testing for the human immuno- deficiency virus [HIV] and initiation on antiretroviral therapy [ART]) and treatment outcomes during the pre-Ebola, Ebola and post-Ebola disease outbreak periods between 2013 and 2016. Design: This was a cross-sectional study and retrospec- tive cohort analysis of treatment outcomes. Results: The mean monthly number of patients with pre- sumptive TB before, during and post-Ebola was respec- tively 169, 145 and 210. The mean monthly number of registered TB cases was respectively 57, 57 and 96. Smear-positive TB was the most frequent type of TB, at 75%, 66% and 77%. The proportion of TB patients tested for HIV was 82% pre-Ebola, 74% Ebola and 99% post-Ebola. The proportion of HIV-positive patients with TB initiated on ART was respectively 46%, 85% and 100%. Treatment success among TB patients was 71% in the pre-Ebola period and 89% in the Ebola period ( P  0.001). Conclusion: During the Ebola outbreak, there were de- creases in the number of presumptive TB patients and in the proportions of patients diagnosed with smear-posi- tive TB and tested for HIV. The initiation of ART in HIV-in- fected TB patients and treatment outcomes remained ac- ceptable. Pre-emptive actions are needed to maintain adequate control activities in future outbreaks.