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TWN Info
Service on UN Sustainable Development (Apr21/02) Geneva, 13 Apr (Kanaga Raja) – The COVID-19 pandemic has had a devastating impact on the continuity of HIV, tuberculosis (TB) and malaria services in low- and middle-income countries in Africa and Asia in 2020, the Global Fund to Fight AIDS, Tuberculosis and Malaria has said. In a new report released on 13 April, the Global Fund said that the data collected shows that for April to September 2020 (compared to the same sixth-month period in 2019): Antenatal first care visits fell by 66% in facilities surveyed in seven countries across Asia, while consultations for under-5 services decreased by 74%; HIV testing across all the facilities surveyed fell 41% in 2020; TB referrals fell 59% in 2020 compared to 2019; and in surveyed facilities in seven countries across Asia, malaria diagnoses fell 56%, and malaria treatment services plummeted by 59%. According to the Global Fund, its snapshot provides an indicative update of how lifesaving HIV, TB and malaria programs and health service continuity have been impacted by COVID-19 across 32 low- and middle-income countries in 2020, and the extent of this disruption. The snapshot is based primarily upon data collected and aggregated through Programmatic Spot-checks recording information from April to September 2019 (Q2/Q3 2019) and from April to September 2020 (Q2/Q3 2020) across 502 health facilities in 32 countries across Africa and Asia. “This snapshot underscores the scale of the challenge,” said Peter Sands, Executive Director of the Global Fund. “HIV prevention has been knocked backwards. With the dramatic drop in case management for malaria, we face a real risk for a spike in mortality. Much of the progress we’ve made to close the gap on finding “missing” people with TB has been reversed. The stark truth is that we will see more incremental deaths from HIV, TB and malaria in 2021 as a consequence of the disruption caused by COVID-19 in 2020,” he added. According to the report by the Global Fund, the COVID-19 pandemic is creating a perfect storm of economic, health and social crises and threatens to reverse the extraordinary gains made by the Global Fund partnership in the fight against HIV, tuberculosis (TB) and malaria and in building resilient and sustainable systems for health. The report said that as COVID-19 rapidly spread in 2020, out-patient consultations at health facilities declined considerably compared to 2019. All health facilities surveyed in the spot-checks describe changes in attendance, highlighting the widespread reach of COVID-19 and its impact. “The main reason patients were no longer coming to health facilities was due to their fear of catching COVID-19, according to 85% of facilities surveyed.” Patients were also no longer able to reach health facilities because of disruption to public transportation services, as well as lockdown and stay-at-home orders. The change in attendance and access to services is particularly dangerous for mothers and children, said the report. It found that antenatal care first visits fell by 5% across Africa, and by a staggering 66% across facilities surveyed in seven countries across Asia. The report said that services for children under 5 were also badly impacted by the pandemic. Facilities across Africa experienced a decrease of 23% in consultations for under-5 services in 2020 relative to 2019, while in seven countries across Asia, these services fell 74%, resulting in significantly fewer children being seen by healthcare workers and receiving lifesaving care. “If mothers and children’s access to essential health services is reduced, mortality among children under 5 could be expected to rise,” said the Global Fund. It noted that HIV and AIDS represented the most recent deadly global pandemic before COVID-19. “The Global Fund has made enormous progress over the past 20 years. In countries where the Global Fund invests, AIDS- related deaths since the Global Fund was founded in 2002 have been reduced by 61% and new infections have been reduced by 41%,” it said. “Prevention efforts are critical to tackle the HIV incidence rate, particularly among key and vulnerable populations such as sex workers, people who inject drugs, prisoners, transgender people, men who have sex with men, as well as young women and adolescent girls who are disproportionately vulnerable to HIV due to gender-based violence and gender-related inequalities,” it added. The Global Fund said that it is committed to scaling up the quality and quantity of HIV prevention programs and to increasing investments in HIV prevention for these key and vulnerable populations. “But COVID-19 is threatening the progress made so far, disrupting some of these crucial HIV services,” it added. Overall, HIV referrals and HIV testing services were particularly affected. The indicative data collected from April to September 2020 shows that HIV referrals, which includes when patients in need of further diagnosis and treatment of HIV or sexually transmitted infections are referred to the next steps in the service continuum, fell 37% in Q2/Q3 of 2020 relative to Q2/Q3 of 2019. In addition, across all the facilities surveyed in its snapshot, HIV testing fell 41%, the Global Fund said, adding that a large decrease in people being tested could lead to an increase in infection rates. “HIV referrals and testing are important strategies for prevention and enabling entry into treatment, and disruption to these services severely impacts countries’ capacity to fight HIV and protect populations at risk,” said the Global Fund. Prior to the arrival of COVID-19, tuberculosis was the world’s leading infectious disease killer, preying on poor and marginalized communities, it said. In countries where the Global Fund invests, TB deaths (excluding HIV positive) since the Fund was founded in 2002 have been reduced by 25%. These gains are now being threatened, it added. “Compared to HIV and malaria, TB was the disease most off-track in 2020, and the COVID-19 pandemic is wiping out painstaking progress made in the past 20 years to accelerate the fight against TB,” said the Global Fund. It said all TB services have been particularly disrupted by COVID-19. TB referrals – which includes when patients suspected of having TB are referred to the next step of diagnosis and treatment – have fallen 59% in Q2/Q3 of 2020 relative to the same period in 2019. Worse, drug-sensitive TB diagnosis and screening services decreased by 44% in the health facilities in its snapshot. “On top of more people dying from undiagnosed TB, this also represents a potentially serious risk to global health security,” said the Global Fund. In surveyed facilities across seven countries in Asia, TB referrals dropped 70% in 2020 in comparison with 2019, and drug-sensitive TB diagnosis and screening services decreased by 52%. The number of patients enrolled on treatment also fell by 46%. In addition, testing for HIV in TB patients declined by 48%, and urban areas were more affected than rural areas. “In the facilities surveyed across Africa, the situation was also concerning, with 29% fewer referrals and a decrease in drug-sensitive TB diagnosis and screening services of 28%.” The Global Fund said in 2020, COVID-19 disruption to malaria services varied across service area. The data from the facilities in its snapshot indicate that surveillance activities monitoring the spread of cases in countries, malaria diagnosis, and malaria treatment have all fallen in 2020 relative to 2019. In surveyed facilities in seven countries across Asia, malaria diagnoses fell 56%, and malaria treatment services plummeted by 59% with all levels of facilities severely affected. Across the reporting African facilities, there was a 17% decrease in malaria diagnosis and a 15% decrease in malaria treatment, with community sites appearing to be more impacted than other facilities. In addition, 21% of facilities in Africa were stocked out of the antimalarial medicine dosage for children under 5 years of age. “As nearly 94% of global malaria cases and deaths occur in Africa, any disruption or decrease in health services on the continent will affect massive numbers of adults and children at risk of contracting malaria,” said the Global Fund. LACK OF TESTS, TREATMENTS AND PPE TO FIGHT COVID-19 According to the Global Fund, at the core of resilient and sustainable health systems are the health workers and community health workers delivering care and services in both formal and informal settings, and COVID-19 has directly threatened their safety and their ability to do their job. In 2020, 50% of facilities surveyed across Africa and 37% of facilities surveyed across seven countries in Asia recorded COVID-19 infections among their staff. Personal Protective Equipment (PPE) is the first layer of protection for health workers treating COVID-19 patients and safely attending patients with HIV, TB, and malaria during a pandemic, said the Global Fund. Yet only 45% of facilities surveyed had at least the four most essential items of PPE available to all staff, including masks, disinfectant, gloves and hand sanitizer. Based on spot-checks done in health facilities in 24 countries in Africa, only 38% of health facilities have enough PPE tracers (masks, disinfectant, gloves, hand sanitizer) for all workers. Of these facilities, only 61% had surgical masks for all workers. In facilities surveyed in seven countries across Asia, only 57% of health facilities had enough PPE tracers for all workers. “Compounding this situation is the severe lack of COVID-19 diagnostic tests available to health facilities,” said the Global Fund. In spot-checks across 24 countries in Africa in 2020, only 11% of facilities could conduct COVID-19 antigen rapid diagnostic tests (Ag RDTs), while 11% could refer samples. Only 8% of facilities across Africa could carry out COVID-19 polymerase chain reaction (PCR) tests, and 37% could refer samples. In the seven countries across Asia included in its snapshot, 17% of facilities were able to conduct Ag RDTs and 2% of facilities could refer samples, while 26% were able to run PCR tests and 26% could refer samples. “This means that countries are operating blind, unable to monitor the rate of COVID-19 infection, detect the emergence of new variants, or measure the efficacy of vaccines,” said the Global Fund. Across countries surveyed in Africa, 7% of facilities reported not having the working refrigerators and cold chain equipment needed to keep traditional vaccines in viable condition, and it is suspected that most will not have the deep freezers required for the mRNA COVID-19 vaccines, it added. Moreover, 23% of facilities did not have the minimum level of needles and syringes required, highlighting some of the challenges ahead. In response to the disruption caused by COVID-19, countries and communities are devising new and innovative approaches to enable services to be implemented safely and mitigate negative impacts on HIV, TB and malaria services, said the Global Fund. More than two-thirds (68%) of facilities surveyed in its snapshot adopted at least one adaptive measure – including in the management of health or community workers and/or in changes in delivery strategies for health services un-related to COVID-19, said the Global Fund. Facilities developed innovative delivery strategies for services un-related to COVID-19. These include shifting the locations of service provision outside or extending drug prescription for long-term use to reduce the number of visits required to healthcare facilities. The distribution of long-lasting insecticidal nets against mosquitoes also continued by switching from a centralized approach to a door-to-door delivery system adapted to the pandemic, said the Global Fund. “In most low- and middle-income countries, the crisis is far from over, with infections and deaths from COVID-19 continuing to increase, and the knock-on impact on HIV, TB and malaria continuing to escalate ” said Global Fund Executive Director Sands. “To regain the ground lost on the three epidemics in 2020 and to step up the fight against COVID-19, we have to massively scale up adaptation programs, increase access to COVID-19 tools, and shore up systems for health so they don’t collapse,” he added.
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