Covid-19, Africa Crisis

If efforts are not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month distruption of antiretroviral therapy could lead to more than 500 000 extra deaths from AIDS related illness, including from tuberculosis. There are many different reasons that could cause services to be interrupted, this modelling exercise makes it clear that communities and partners need to take action now as the impact of a six-month distribution of antiretroviral therapy could effectively set the clock on AIDS related deaths back to 2008 where more than 950 000 AIDS related deaths were observed.

In a modelling group convened by the World Health Organisation and UNAIDS, Dr Tedros Adhanom Ghebreyesus said, “We must read this as a wake-up call to countries to identify ways to sustain all vital health services. For HIV, some countries are already taking important steps, for example ensuring that people can collect bulk packs of treatment, and other essential commodities, including self-testing kits, from drop-off points, which relieves pressure on health services and health work force. We must also ensure that global supplies of tests and treatments continue to flow to the countries that need them.

In sub-Saharan Africa, an estimated 25.7 million people were living with HIV and 16.4 million 64% were taking antiretroviral therapy in 2018. Those people are now at risk of having their treatment interrupted because HIV services are closed or are unable to supply antiretroviral therapy because of disruptions to the supply chain or because services simply become overwhelmed due to competing needs to support the COVID-19 pandemic response.

“The COVID-19 pandemic must not be an excuse to divert investment from HIV,” said Winnie Byanyima, Executive Director of UNAIDS.

She added, “There is a risk that the hard-earned gains of the AIDS response will be sacrificed to the fight against COVID-19, but the right to health means that no one disease should be fought at the expense of the other.”  

When a person is unable to take antiretroviral therapy regularly, the viral load increase, impacting the person’s health, which can ultimately lead to death. Even relatively short-term interruptions to treatment can have significant negative impact on a person’s health and potential to transmit HIV.

This research brought together five teams of modellers using different mathematical models to analyse the effects of various possible disruptions to HIV testing, prevention and treatment services caused by COVID-19.

Each model looked at the potential impact of treatment disruptions of three months or six months on AIDS mortality and HIV incidence in sub-Saharan Africa. In the six-month disruption scenario, estimates of excess AIDS related deaths in one year ranged from 471 000 to 673 00, making it inevitable that the world will miss the global 2020 target of fewer than 500 000 AIDS related deaths worldwide.

HIV clinician Dr Moeketsi Mathe who specialises in infectious diseases said, in South Africa there has been a lot of misinformation where people were so afraid, there was so much fear that even at clinics some people were turned away when they came to collect their treatment, or they were told that their clinics are closed down. He further says, “patients must stand up and insist on getting treatment and advocate for access in these lifesaving drugs.”

The disrupted services could also reverse gains made in preventing mother to child transmission of HIV. Curtailment of these services by COVID-19 for six months could see new child HIV infections rise drastically, by as much as 37% in Mozambique, 78% in Malawi, 78% in Zimbabwe and 104% in Uganda.

“Every death is a tragedy, we cannot sit by and allow hundreds of thousands of people, many of them young, to die needless deaths. I urge governments to ensure that every man, women and child living with HIV gets regular supplies of antiretroviral therapy something that is literally a lifesaver.” Said Ms Byanyima.

Other significant affects of the COVID-19 pandemic on the AIDS response in sub-Saharan Africa that could lead to additional mortality include reduced quality clinical care owing to health facilities becoming overstretched and a suspension of viral load testing, reduced adherence counselling and drug regimen switches.

This research highlights the need for urgent efforts to ensure continuity to HIV prevention and treatment services in order to avert excess HIV related deaths and to prevent increase in HIV incidence during the COVID-19 pandemic.

By Sakhe Dolonga

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