The potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria control in Africa: a systematic review of modelling studies and population surveys

Abstract

Background We reviewed current evidence on the impact of COVID-19 on HIV, tuberculosis, and malaria across Africa.Methods We searched medical databases up to 15 September 2020 for epidemiological studies that investigated the impact of COVID-19 on HIV, tuberculosis, and malaria in terms of morbidity, mortality, or healthcare accessibility, covering African countries. We consulted global health and government sources for population surveys providing relevant primary data. We employed meta-study to assess evidence. This study is registered with PROSPERO, number CRD42020209265.Results Of the 128 records screened, 14 epidemiological studies were included in the analysis. We identified 5 population surveys. The largest effect of COVID-19 related disruption of HIV, TB, and malaria services is projected to result from interruption of ART, decline in TB case detection, and interruption of insecticide treated bed nets distribution campaigns, respectively. However, most modelling studies substantially underestimated the potential implications of COVID-19 on HIV, TB, and malaria in Africa and focused on the disruption of healthcare resulting from reduction in the capacity of healthcare provider. Reduced capacity of patients to use health services and adhere to treatment may also contribute to poor outcomes even when health systems capabilities are restored or unaffected. Moreover, these models do not account for any potential interaction of HIV, TB, and malaria with COVID-19, although empirical evidence shows that coinfection between HIV and TB with COVID-19 is significantly associated with increased mortality risk in Africa.Conclusions Current evidence is largely speculative. Innovative COVID-19 resilient solutions calibrated to local vulnerabilities are vital to ensure continuity of care and prevent the emergence of further potentially larger crises.

Effects of COVID-19 pandemic on ART Service delivery: perspectives of healthcare workers in a Teaching Hospital in Ghana

“…Although initially successful, the strategy had to be shelved as the facility experienced ARV shortages during the pandemic. This disruption in ART supply and distribution during the pandemic was projected by several modelling studies [ 34 , 35 ]. Further to this, UNAIDS reports that the pandemic has caused disruptions in health service delivery and unequal access to ART globally, and therefore anticipates that HIV targets set for 2020 may not be achieved by most countries [ 12 , 36 ].…”

Public health relevant consequences of the COVID-19 pandemic on malaria in sub-Saharan Africa: A scoping review

“…Co-infection with malaria may complicate COVID-19, while immunomodulation caused by previous malaria exposure may result in less severe COVID-19, as previously also shown in other respiratory diseases (72)(73)(74)(75). Reduced access to health care services due to direct and indirect effects of the pandemic has a negative impact on access to antimalarial treatment, thus it would likely have a major effect on the malaria burden in endemic countries (17,49,53). This will be compounded by the clear negative impact of the pandemic on global supply chains for curative and preventive malaria commodities (48,52).…”

“…Some international companies switched from the production of malaria products to COVID-19 products (47,49,51). Difficult access to health facilities lowered the availability of essential drugs and increased their price, with subsequent increases in purchase and usage of sub-standard drugs and alternative medicines (28,(51)(52)(53). In addition, PPE needed for the implementation of different malaria services (e.g.…”

“…The largest effects may occur if the COVID-19 transmission peaks and the planned malaria campaigns overlap (21,23,53,55). About three quarters of malaria-affected countries reported disruptions of malaria services and programs (17,32,48,50,53,(56)(57)(58). (48,50,57).…”

“…(33,48). Disrupted ITN programs will lead to increased malaria transmission as 80% of the nets are distributed through mass campaigns (22,48,53,55). IRS campaigns face many challenges as they require direct household contact (33,50,57).…”