Impact of the Ebola virus disease outbreak (2014-2016) on Tuberculosis Surveillance Activities in Guinea's National Tuberculosis Program: A Time Series Analysis

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Abstract Background Tuberculosis (TB) is a major cause of disease and death worldwide. According to World Health Organization (WHO) estimates, Guinea is a country with a high incidence of tuberculosis (TB) and TB / HIV co-infection. In March 2014, the WHO announced the Ebola virus disease (EVD) outbreak in Guinea that caused a health system disruption. Our study aimed to assess the impact of the Ebola virus disease outbreak on the TB surveillance system through the main indicators of TB-related morbidity and mortality. Methods This is a retrospective cohort study comparing TB trends using TB surveillance data from periods before (2011-2013), during (2014-2016) and after (2017-2018) the Ebola virus disease outbreak. A time-series analysis was conducted to investigate the link between the decrease in TB incidence and the Ebola virus disease through cross-correlation. We evaluated the lag observed in the cross-correlation test using the ANCOVA type II delayed variable dependent model. The current status of the surveillance system was compared to that of 2015 during the EVD through the Standards and benchmarks for TB surveillance and vital registration systems established by WHO. Results The reporting rate of TB cases decreased from 120 cases per 100,000 in 2011 to 100 cases per 100,000 in 2014, while the EVD outbreak was at its peak. The cross-correlation test between the time series of incident cases of all forms of TB and Ebola shows a significant lag of -0.4 (40%), which corresponds to the decrease in the incidence of TB cases observed when the EVD was steep in 2014 (p-value=0.024). However, the EVD had no negative impact on patient treatment outcomes (p-value=0.258). Regarding the surveillance system, out of 13 WHO standards and benchmark, five were reached in 2019 compared to three in 2015. Conclusion The EVD outbreak had a severe impact on TB surveillance in Guinea, with a significant decline in TB reporting rates during the epidemic period. The introduction of an early warning system would preserve the TB surveillance system ; which could encourage the implementation of interventions to ensure access to diagnosis, and enhanced surveillance for the treatment of TB.

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