Several health services have been negatively affected by COVID-19 outbreaks, partly due to overburdened systems. In low- and middle-income countries with high rates of HIV, tuberculosis, and malaria, disrupted services could result in premature deaths over the next five years.
During the largest epidemic in history, the WHO has warned against diverting funds from programs fighting HIV, TB, and malaria. Despite this, USD 1.7 billion is being diverted from health into security because of the Covid outbreak. This is equivalent to the amount needed to treat all three diseases over two years.
In light of rising COVID-19 mortality rates worldwide, it has become increasingly evident that vulnerable populations are disproportionately affected. Vulnerable people include those who live in densely populated areas, those with low socioeconomic status, migrants, and minorities. There are higher rates of comorbid chronic conditions in these groups, placing them at higher risk for infections and severe disease consequences.
Services to prevent disease (voluntary medical male circumcision, pre-exposure prophylaxis, long-lasting insecticide-treated nets [LLINs], and seasonal malaria prevention) have been suspended or reduced; ongoing treatment (for HIV and tuberculosis) and new acute treatment (for malaria) have been cut by 25 to 50 per cent during peak demand periods, as well as treatment for those newly seeking care (HIV or tuberculosis testing and treatment).
The Xpert MTB/Rif molecular diagnostic tool, intended to diagnose tuberculosis accurately, was potentially repurposed for COVID-19 diagnosis, further driving down diagnosis and treatment rates for tuberculosis.
HIV experts and communities have often stepped up and provided support during the worst of the crisis. The worldwide response has drawn on decades of experience in combating AIDS. Globally, many countries responded quickly, addressing vulnerabilities, maintaining health services, and creating synergies between AIDS control and COVID-19. By doing so, HIV and COVID-19 threats are dealt with simultaneously.
Despite a decline of 23% in HIV-new infections since 2010, the COVID-19 pandemic may reverse this trend, and populations already behind may fall further behind. Recovery programs are therefore essential for areas with high HIV rates, as are programs for tuberculosis and malaria to reduce the health impact of the COVID-19 pandemic.
Priorities for reducing the effects of COVID-19 include maintaining services such as HIV and tuberculosis treatment (for new and existing patients), malaria prophylactic treatment, and LLIN distribution.
As a result of social distancing measures instituted by COVID-19, it is estimated that HIV transmission and tuberculosis transmission would be reduced by 10%.
Insufficient national and global investments in pandemic readiness are exposed by the recent HIV and COVID-19 pandemics and their responses. Health systems will need to be more resilient in the long run in order to handle shock events such as pandemics.
Together with HIV, TB and Malaria, COVID-19 should build synergies to make sure that they increase access to services, decrease the risk of infection and disease, and impact programme outcomes.