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. 2020 Sep;8(9):e1132-e1141.
doi: 10.1016/S2214-109X(20)30288-6. Epub 2020 Jul 13.

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

Alexandra B Hogan  1 , Britta L Jewell  1 , Ellie Sherrard-Smith  1 , Juan F Vesga  1 , Oliver J Watson  1 , Charles Whittaker  1 , Arran Hamlet  1 , Jennifer A Smith  1 , Peter Winskill  1 , Robert Verity  1 , Marc Baguelin  1 , John A Lees  1 , Lilith K Whittles  1 , Kylie E C Ainslie  1 , Samir Bhatt  1 , Adhiratha Boonyasiri  1 , Nicholas F Brazeau  1 , Lorenzo Cattarino  1 , Laura V Cooper  1 , Helen Coupland  1 , Gina Cuomo-Dannenburg  1 , Amy Dighe  1 , Bimandra A Djaafara  1 , Christl A Donnelly  2 , Jeff W Eaton  1 , Sabine L van Elsland  1 , Richard G FitzJohn  1 , Han Fu  1 , Katy A M Gaythorpe  1 , William Green  1 , David J Haw  1 , Sarah Hayes  1 , Wes Hinsley  1 , Natsuko Imai  1 , Daniel J Laydon  1 , Tara D Mangal  1 , Thomas A Mellan  1 , Swapnil Mishra  1 , Gemma Nedjati-Gilani  1 , Kris V Parag  1 , Hayley A Thompson  1 , H Juliette T Unwin  1 , Michaela A C Vollmer  1 , Caroline E Walters  1 , Haowei Wang  1 , Yuanrong Wang  1 , Xiaoyue Xi  1 , Neil M Ferguson  1 , Lucy C Okell  1 , Thomas S Churcher  1 , Nimalan Arinaminpathy  1 , Azra C Ghani  1 , Patrick G T Walker  1 , Timothy B Hallett  3
Affiliations

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

Alexandra B Hogan et al. Lancet Glob Health. 2020 Sep.

Erratum in

  • Correction to Lancet Glob Health 2020; 8: e1132-41.
    [No authors listed] [No authors listed] Lancet Glob Health. 2021 Jan;9(1):e23. doi: 10.1016/S2214-109X(20)30433-2. Epub 2020 Oct 16. Lancet Glob Health. 2021. PMID: 33075277 Free PMC article. No abstract available.

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.

Findings: 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.

Interpretation: 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.

Funding: Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.

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Figures

Figure 1
Figure 1
Deaths due to COVID-19 and hospital capacity in each pandemic scenario (A) Cumulative deaths due to COVID-19 per million population. (B) Patients with COVID-19 requiring non-critical care in hospital as a proportion of total hospital capacity. Dashed lines indicate the thresholds of high (50%) and extremely high (100%) health system demand.
Figure 2
Figure 2
Patterns of disruption to health care in each pandemic scenario Black lines show the number of COVID-19 deaths per day for each. The periods indicated with the shaded bars show the timings of the different types of disruption.
Figure 3
Figure 3
Additional deaths due to HIV, tuberculosis, and malaria resulting from the impact of COVID-19 For HIV, setting 1 is a very high HIV prevalence setting (20% among 15–49-year-olds in 2018) typical in southern Africa; setting 2 is a high HIV prevalence setting (9% among 15–49-year-old adults in 2018) typical in eastern Africa. For tuberculosis, setting 1 is a very high burden setting (tuberculosis incidence of 520 per 100 000 population in 2018) typical in southern Africa; setting 2 is a moderate burden setting (tuberculosis incidence of 45 per 100 000 population in 2018) typical in South America. For malaria, setting 1 is a generic high malaria burden setting with seasonality of transmission typical of a west African country (around 386 000 malaria cases per million people in 2018); setting 2 is a generic moderate burden setting with seasonality of transmission typical of a country in eastern Africa (around 7000 malaria cases per million people in 2018).
Figure 4
Figure 4
Additional deaths (upper panels) and years of life lost (lower panels) due to the COVID-19 pandemic and related disruption to care for HIV, tuberculosis, and malaria in 2020–24 For HIV, setting 1 is a very high HIV prevalence setting (20% among 15–49-year-olds in 2018) typical in southern Africa; setting 2 is a high HIV prevalence setting (9% among 15–49-year-old adults in 2018) typical in eastern Africa. For tuberculosis, setting 1 is a very high burden setting (tuberculosis incidence of 520 per 100 000 population in 2018) typical in southern Africa; setting 2 is a moderate burden setting (tuberculosis incidence of 45 per 100 000 population in 2018) typical in South America. For malaria, setting 1 is a generic high malaria burden setting with seasonality of transmission typical of a west African country (around 386 000 malaria cases per million people in 2018); setting 2 is a generic moderate burden setting with seasonality of transmission typical of a country in eastern Africa (around 7000 malaria cases per million people in 2018).
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References

    1. Walker PGT, Whittaker C, Watson OJ. The impact of COVID-19 and strategies for Mitigation and suppression in low- and middle-income countries. Science. 2020 doi: 10.1126/science.abc0035. published online June 12. - DOI - PMC - PubMed
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