Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study

publication
Lancet Glob Health 8(9):e1132-e1141
Author

Alexandra B Hogan, Britta L Jewell, Ellie Sherrard-Smith, Juan F Vesga, Oliver J Watson, Charles Whittaker, Arran Hamlet, Jennifer A Smith, Peter Winskill, Robert Verity, Marc Baguelin, John A Lees, Lilith K Whittles, Kylie E C Ainslie, Samir Bhatt, Adhiratha Boonyasiri, Nicholas F Brazeau, Lorenzo Cattarino, Laura V Cooper, Helen Coupland, Gina Cuomo-Dannenburg, Amy Dighe, Bimandra A Djaafara, Prof Christl A Donnelly, Jeff W Eaton, Sabine L van Elsland, Richard G FitzJohn, Han Fu, Katy A M Gaythorpe, William Green, David J Haw, Sarah Hayes, Wes Hinsley, Natsuko Imai, Daniel J Laydon, Tara D Mangal, Thomas A Mellan, Swapnil Mishra, Gemma Nedjati-Gilani, Kris V Parag, Hayley A Thompson, H Juliette T Unwin, Michaela A C Vollmer, Caroline E Walters, Haowei Wang, Yuanrong Wanga, Xiaoyue Xi, Prof Neil M Ferguson, Lucy C Okell, Thomas S Churcher, Nimalan Arinaminpathy, Prof Azra C Ghani, Patrick G T Walker, Prof Timothy B Hallett

Published

September 1, 2020

Doi

https://doi.org/10.1016/S2214-109X(20)30288-6

Abstract

Background

COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years.

Methods

Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic.

Results

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. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics.

Conclusions

Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic.

Citation

Hogan, Alexandra B et al. 2020. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. The Lancet Global Health, Volume 8, Issue 9, e1132 - e1141 DOI