Turning threats into opportunities: how to implement and advance quality TB services for people with HIV during the COVID‐19 pandemic and beyond

Abstract

Introduction: Until COVID-19, tuberculosis (TB) was the leading infectious disease killer globally, disproportionally affecting people with HIV. The COVID-19 pandemic is threatening the gains made in the fight against both diseases. Discussion: Although crucial guidance has been released on how to maintain TB and HIV services during the pandemic, it is acknowledged that what was considered normal service pre-pandemic needs to improve to ensure that we rebuild person-centred, inclusive and quality healthcare services. The threat that the pandemic may reverse gains in the response to TB and HIV may be turned into an opportunity by pivoting to using proven differentiated service delivery approaches and innovative technologies that can be used to maintain care during the pandemic and accelerate improved service delivery in the long term. Models of care should be convenient, supportive and sufficiently differentiated to avoid burdensome clinic visits for medication pick-ups or directly observed treatments. Additionally, the pandemic has highlighted the chronic and short-sighted lack of investment in health systems and the need to prioritize research and development to close the gaps in TB diagnosis, treatment and prevention, especially for children and people with HIV. Most importantly, TB-affected communities and civil society must be supported to lead the planning, implementation and monitoring of TB and HIV services, especially in the time of COVID-19 where services have been disrupted, and to report on legal, policy and gender-related barriers to access experienced by affected people. This will help to ensure that TB services are held accountable by affected communities for delivering equitable access to quality, affordable and non-discriminatory services during and beyond the pandemic. Conclusions: Successfully reaching the related targets of ending TB and AIDS as public health threats by 2030 requires rebuilding of stronger, more inclusive health systems by advancing equitable access to quality TB services, including for people with HIV, both during and after the COVID-19 pandemic. Moreover, services must be rights-based, community-led and community-based, to ensure that no one is left behind.

Integrating health planning and primary care infrastructure for COVID‐19 and tuberculosis care in India: Challenges and opportunities

“…It has been recommended that refocus on rebuilding of stronger, more inclusive health systems by advancing equitable access is the key to achieving the targets of eliminating TB as a public health problem by 2025 46 . One of the key factors in implementing this inclusive strategy is having a community led and community‐based approach.…”

“…It has been recommended that refocus on rebuilding of stronger, more inclusive health systems by advancing equitable access is the key to achieving the targets of eliminating TB as a public health problem by 2025. 46 One of the key factors in implementing this inclusive strategy is having a community led and community‐based approach. Our solutions of utilising the services of ASHA workers are in line with these mandates as the frontline health worker is usually from the community and has an intimate and intuitive knowledge of needs as well as challenges for the community.…”

Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB) Among Children: Where We Stand Now

“…Unfortunately, the registration of children was low in number. Fewer enrollments have jeopardized our global targets for ending TB, which is already beyond our reach [ 66 , 98 ]. From 2018 to 2021, the percentage of enrollment was only 43% of our five-year target (2018-2022); in drug-resistant pediatric cases, it was only 15% [ 66 ].…”

Impact of the COVID‐19 pandemic on TB services at ART programmes in low‐ and middle‐income countries: a multi‐cohort survey

“…There is a need to closely monitor the negative effects of the pandemic on TB prevention and care and restore adequate TB care, particularly in high‐TB burden settings and among vulnerable populations, such as people living with HIV [ 4 , 12 ]. In this study, we analysed trends in the number of newly diagnosed persons affected by TB at antiretroviral therapy (ART) clinics in Africa and the Asia‐Pacific, and the influence of the COVID‐19 pandemic on HIV and TB services in these programmes.…”

“…Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland;2 The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA; 3 Department of Medicine, Moi University School of Medicine, Eldoret, Kenya; 4 Department of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya; 5 University of Bordeaux, Inserm U1219, IRD EMR271, Bordeaux, France;6 Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA;7 Centre National de Référence en matière de VIH/SIDA Burundi (CNR), Bujumbura, Burundi;8 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand;9 Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia;10 Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;11 Emory Rollins School of Public Health, Emory University, Atlanta, Georgia, USA;12 Centre for Infectious Disease Epidemiology and…”