Potential Disruptions in HIV, TB, and Malaria Response due to COVID-19

Concerns are being raised for COVID-19 and the potential impact on HIV, tuberculosis, and malaria in low-income and middle-income countries. A team of researchers recently addressed this issue with a modeling study.

Large outbreaks or pandemics cause devastation that isn’t an insulated vacuum. The impact of COVID-19 extends beyond the millions of cases and hundreds of thousands who have lost their lives in the United States alone, but also bleeds into the deeply-rooted inequality that exists, as well as the vulnerability of the economy.

One particular piece to the pandemic, or really any large-scale outbreak, is the impact it might have on other health outcomes. From excessive deaths because people are avoiding hospitals or the ability to provide care is diminished, these events have serious rippling effects. For example, during the Ebola outbreak in 2014/2016, all eyes were on the impact of this hemorrhagic fever, which often led to neglect of other health outcomes.

The Centers for Disease Control and Prevention (CDC) has noted that there were over 10,000 additional deaths due to untreated conditions in Guinea, Liberia, and Sierra Leone alone. In terms of other infectious diseases, the CDC found 1,091 additional deaths due to HIV, 2,714 additional estimated deaths due to tuberculosis, and 6,818 additional deaths due to malaria.

These same concerns are being raised for COVID-19 and the potential impact on HIV, tuberculosis, and malaria in low-income and middle-income countries. A team of researchers recently addressed this issue with a modelling study published in The Lancet. The goal was ultimately to address and quantify the impact COVID-19 has on services for these three infectious diseases over the next five years.

Utilizing a basic reproductive number of 3.0, the team then “constructed four scenarios that describe a range of possible trajectories for the resulting COVID-19 pandemic in low-income and middle-income countries (two representative settings for each disease) with respect to the effect that interventions have on reducing the effective reproduction number.”

Four scenarios were used for response—no action, mitigation for 6 months, suppression for 2 months, or suppression for one year. Pulling on transmission models for the three infectious diseases, they then estimated the impact within specific settings as a result of limited health intervention activities.

The authors noted that “In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions.”

For malaria, the interruption in prevention efforts was within planned net campaigns. When reviewing the impact, the authors noted that as a result of these disruptions to critical intervention services, there could be a loss of life-years.

Ultimately, more studies like this are needed to not only address the impact to critical public health and intervention efforts, but also emphasize that robust public health and healthcare infrastructures are needed. When disruptions occur due to a lack of resources and ability to respond to new biological threats, this is a clear indication that investment in public health is insufficient.