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. 2021 May 19;6(2):81.
doi: 10.3390/tropicalmed6020081.

Assessing the Impact of COVID-19 on TB and HIV Programme Services in Selected Health Facilities in Lilongwe, Malawi: Operational Research in Real Time

Pruthu Thekkur  1   2 , Hannock Tweya  3 , Sam Phiri  3 , James Mpunga  4 , Thokozani Kalua  5 , Ajay M V Kumar  1   2   6 , Srinath Satyanarayana  1   2 , Hemant D Shewade  1   2 , Mohammed Khogali  7 , Rony Zachariah  7 , I D Rusen  8 , Selma Dar Berger  1 , Anthony D Harries  1   9
Affiliations

Assessing the Impact of COVID-19 on TB and HIV Programme Services in Selected Health Facilities in Lilongwe, Malawi: Operational Research in Real Time

Pruthu Thekkur et al. Trop Med Infect Dis. .

Abstract

When the COVID-19 pandemic was announced in March 2020, there was concern that TB and HIV programme services in Malawi would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in eight health facilities in Lilongwe to see if it was possible to counteract the anticipated negative impact on TB case detection and treatment and HIV testing. Aggregate data were collected monthly during the COVID-19 period (March 2020-February 2021) using an EpiCollect5 application and compared with monthly data collected during the pre-COVID-19 period (March 2019-February 2020); these reports were sent monthly to programme directors. During COVID-19, there was an overall decrease in persons presenting with presumptive pulmonary TB (45.6%), in patients registered for TB treatment (19.1%), and in individuals tested for HIV (39.0%). For presumptive TB, children and females were more affected, but for HIV testing, adults and males were more affected. During COVID-19, the TB treatment success rate (96.1% in pre-COVID-19 and 96.0% during COVID-19 period) and referral of HIV-positive persons to antiretroviral therapy (100% in pre-COVID-19 and 98.6% during COVID-19 period) remained high and largely unchanged. Declining trends in TB and HIV case detection were not redressed despite real-time monthly surveillance.

Keywords: COVID-19; EpiCollect5; HIV; Lilongwe; Malawi; TB treatment outcomes; antiretroviral therapy; operational research; presumptive tuberculosis; tuberculosis.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Cumulative number of COVID-19 cases and deaths in Malawi between March 2020 and February 2021 as reported to the World Health Organization.
Figure 2
Figure 2
Numbers presenting each month with presumptive PTB in eight health facilities in Lilongwe, Malawi, during the pre-COVID-19 and COVID-19 periods. From October 2020 onwards, health workers were asked to pro-actively ask about symptoms of TB in those attending outpatient departments; there was an active tracing of patients needing to be registered.
Figure 3
Figure 3
Numbers presenting each month with registered TB in eight health facilities in Lilongwe, Malawi, during the pre-COVID-19 and COVID-19 periods. From October 2020 onwards, health workers were asked to pro-actively ask about symptoms of TB in those attending outpatient departments; there was an active tracing of patients needing to be registered.
Figure 4
Figure 4
Treatment success amongst those enrolled each month in eight health facilities in Lilongwe, Malawi, during pre-COVID-19 and COVID-19 periods. Enrolment occurred 8 months prior to the month of reporting (to allow for 6-months treatment and 2-months to follow-up and record the final outcome).
Figure 5
Figure 5
Numbers presenting each month for HIV testing in eight facilities in Lilongwe, Malawi, during pre-COVID-19 and COVID-19 periods. HIV services resumed after lockdown; HIV testing was also offered to contacts of HIV-positive index clients.
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