Dear Madam Editor:

I have read the article "Characteristics and frequency of tuberculosis before and during the COVID-19 pandemic among adults treated in a primary healthcare center in Lima, Peru, 2019-2020" ¹ with great interest. It was written by Calixto et al. and published in Horizonte Médico (Lima) journal, volume 23, issue 1, and concluded that in 2020 the prevalence of tuberculosis (TB) was higher in a primary healthcare center because of a reduced implementation of the TB programs due to the COVID-19 pandemic. Therefore, it is appropriate to reflect on such matter because of its high importance.

Every research encouraging to question the current approach to such disease at the different health levels contributes to improve the quality of service and, particularly, to correct mistakes that have turned Peru into one of the countries with more burden of TB and multidrug-resistant tuberculosis (MDR TB), not only in Latin America but worldwide. The high prevalence of such disease in this country may be explained by the population’s sociodemographic, clinical and environmental factors mostly evidenced in the epidemiologic context of the COVID-19 pandemic. Thus, research results allow developing critical thinking among readers and setting up new strategies to approach the current issues ².

Dilas et al. ³ mention nurses’ potential to significantly contribute to the success in the treatment of TB patients since they play a leading educational role to help them improve their preventive behavior, which generates more participation and lower prevalence of subjects affected by TB. Also, they state that according to research studies health education (HE) may be essential for the success of treatment adherence. Hence, the results show the positive and significant effect of social support on HE. Likewise, they claim that TB patients need health information and motivation-based social support as well as treatment adherence surveillance.

In contrast, it is evident that there is little relationship between the approach to risk factors, HE and TB programs given by different health levels in Peru, which has been previously reported by Ortiz-Ruiz et al. ⁴ and by Dilas et al. They state that pharmacological treatment alone is not enough since fighting this disease involves a comprehensive approach ³, which agrees with the sociodemographic factors found by Calixto et al. ¹.

Considering such findings, there should be a comprehensive approach to treat TB patients, as well as social support to favor adherence to TB drugs. This will contribute to improve psychological health, decrease stress and increase self- efficacy in the presence of the disease. Both physicians and nurses should exert more influence and increase motivation for the treatment of TB patients ^3,4.

Therefore, the dissemination of the article is necessary since there is the risk that TB can become an incurable disease because of resistance to drugs and mismanagement of pharmacovigilance and disease control programs. In consequence, identifying the issues will allow preparing comprehensive and sustainable plans over time.