Bi-directional screening for COVID-19, tuberculosis and diabetes in flu, DOTS and NCD clinics in a rural hospital in Northern India

Introduction: To assess the status of bi-directional screening for COVID-19, tuberculosis and diabetes among people attending Non-communicable Disease (NCD), Directly Observed Treatment Short-course (DOTS), and flu clinics of a secondary care hospital in rural northern India. Material and Methods: A cross-sectional, analytical study was conducted among the eligible (aged ≥18 years) population who attended the study clinics in a rural sub-district hospital. In the flu clinic, consecutive patients were assessed for screening for TB (symptom-based) and diabetes (random blood sugar) and status of referral to DOTS and NCD clinics. Similarly, the screening for diabetes and COVID-19, Reverse Transcription-Polymerase Chain Reaction (RT-PCR) in the DOTS clinic, and TB and COVID-19 in the NCD clinic were assessed. The independent association of factors with COVID-19 positivity were assessed by calculating the adjusted prevalence ratios (aPR) at 95% confidence interval (CI). Results: Of the 405 people assessed, 279 (68.9%), 102 (25.2%), and 24 (5.9%) were from flu, NCD, and DOTS clinics, respectively. 26 (25.5%) and 22 (91.7%) of NCD and DOTS clinic patients underwent RT-PCR for COVID-19. TB screening in NCD and flu clinics was done among 4 (3.9%) and 7 (12.5%), respectively. A total of 23 (9.0%) were found positive for COVID-19, and no factors other than the presence of COVID-19 symptoms (aPR: 2.89; 95% CI: 1.33–6.29) had any independent association with COVID-19 positive status. Conclusion: The low screening for TB in NCD and flu clinics indicates the need to strengthen the implementation the TB-DM and TB-COVID-19 bidirectional screening. Similarly, the low screening or testing for COVID-19 in the NCD clinic can be improved by the implementation of systematic screening strategies like TB-DM bidirectional screening.