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,Srinath Satyanarayana,Ajay M V Kumar,I D Rusen,Sam Phiri,Mohammed Khogali,Selma Dar Berger,Thokozani Kalua,James Mpunga,Rony Zachariah,Hannock Tweya,Hemant D Shewade,Anthony D Harries

doi:10.3390/tropicalmed6020081

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.

Highlights

In early January 2020, a new coronavirus named “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) was identified in China as the cause of a cluster of atypical pneumonia cases in Wuhan city, Hubei Province
Malawi is among the top countries globally with a high burden of TB and HIV/AIDS: in 2019, there were an estimated 27,000 people with TB, of whom 13,000 were HIV positive [19], and there were 1 million people living with HIV (PLHIV) of all ages [20]
In terms of the general effects of COVID-19 on health services, the government of Malawi declared a national disaster in March 2020 and ordered a national lockdown

Summary

Introduction

In early January 2020, a new coronavirus named “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) was identified in China as the cause of a cluster of atypical pneumonia cases in Wuhan city, Hubei Province. The disease that it causes, coronavirus disease 2019 (COVID-19), spread with frightening rapidity across the world. March 2020, the World Health Organization (WHO) declared COVID-19 to be a global pandemic. At the start of the pandemic, the epicentres were in China, certain European countries, and the United States. The large volumes of air traffic between these countries and Africa led to concerns that sub-Saharan Africa might be hard hit by COVID-19 [2,3]

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