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, 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 CouplandGina Cuomo-Dannenburg, Amy Dighe, Bimandra A. Djaafara, 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 Wang, Xiaoyue Xi, Neil M. Ferguson, Lucy C. Okell, Thomas S. Churcher, Nimalan Arinaminpathy, Azra C. Ghani, Patrick G.T. Walker, Timothy B. Hallett*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

176 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)e1132-e1141
JournalThe Lancet Global Health
Volume8
Issue number9
DOIs
Publication statusPublished - Sep 2020
Externally publishedYes

Bibliographical note

Funding Information:
ABH acknowledges support from an Imperial College Research Fellowship. BLJ, JFV, JAS, NA, ACG, and TBH acknowledge support from the Bill & Melinda Gates Foundation. OJW, NMF, ACG, and PGTW acknowledge support from the Wellcome Trust and the UK Department for International Development (DFID). The Centre for Global Infectious Disease Analysis is jointly funded by the UK Medical Research Council (MRC) and DFID under the MRC/DFID Concordat agreement and is also part of the EDCTP2 programme supported by the EU.

Funding Information:
BLJ reports personal fees from Kaiser, outside of the submitted work. JAS reports personal fees from the Bill & Melinda Gates Foundation and grants from the US Agency for International Development and the Bill & Melinda Gates Foundation, outside of the submitted work. TBH reports personal fees from the Global Fund, WHO, and the Bill & Melinda Gates Foundation, outside of the submitted work. All other authors declare no competing interests.

Funding Information:
ABH acknowledges support from an Imperial College Research Fellowship. BLJ, JFV, JAS, NA, ACG, and TBH acknowledge support from the Bill & Melinda Gates Foundation. OJW, NMF, ACG, and PGTW acknowledge support from the Wellcome Trust and the UK Department for International Development (DFID). The Centre for Global Infectious Disease Analysis is jointly funded by the UK Medical Research Council (MRC) and DFID under the MRC/DFID Concordat agreement and is also part of the EDCTP2 programme supported by the EU.

Publisher Copyright:
© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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