DISRUPTIONS IN HIV, TB AND MALARIA PROGRAMS DUE TO COVID-19

What survey data tell us

By The Global Fund

July 10^th, 2020

The latest survey results of the "COVID-19 Country Monitoring Tool" show widespread disruptions to HIV, TB and malaria work as a result of the COVID-19 pandemic.

At least three-quarters of countries have reported moderate, high or very high disruptions in delivery of HIV and TB services, while two-thirds of countries reported at least moderate disruptions to malaria service provision.

The results of this qualitative survey indicate challenges to HIV prevention; testing and case finding for HIV, TB and malaria; cancelled or delayed prevention activities; and medical and laboratory staff being reassigned to the fight against COVID-19.

Qualitative data from the survey indicates lockdowns, restriction on gatherings of people and transport stoppages are the main reasons activities have been cancelled or delayed. Additional causes of disruption include COVID-related stigma and reluctance of health workers to attend to people suspected of having TB or malaria – which have many of the same initial symptoms as COVID-19; and clients not seeking health services as usual, resulting from fear of getting infected with COVID-19 as well as economic hardships caused by the pandemic.

The following graphs show the various levels of disruption reported by countries through the survey results as of 15 June, 2020. Percentages represent the share of all countries surveyed.

DISRUPTIONS IN HIV, TB AND MALARIA PROGRAMS DUE TO COVID-19

The latest results show a slight reduction in the number of countries reporting disruptions, compared to the 1 June survey:

20% of HIV programs reported low/no disruptions in the latest survey, compared to 15% in the previous survey (an improvement of 5 percentage points);
23% of TB programs reported low/no disruptions in the latest survey, compared to 20% in the previous survey (an improvement of 3 percentage points);
31% of malaria programs reported low/no disruptions in the latest survey, compared to 24% in the previous survey (an improvement of 7 percentage points).

However, the level of severity of disruptions seems has slightly worsened for HIV and TB, while showing a slight improvement for malaria:

21% of HIV programs reported high/very high levels of disruptions in the latest survey, compared to 18% in the previous survey (a worsening of 3 percentage points);
19% of TB programs reported high/very high levels of disruptions in the latest survey, compared to 17% in the previous survey (a worsening of 2 percentage points);
15% of malaria programs reported high/very high levels of disruptions in the latest survey, compared to 19% in the previous survey (an improvement of 4 percentage points).

Compared to the 1 June survey data, some improvements were seen in in-country supply chain, for both warehousing (an improvement of 8 percentage points of countries reporting no/low disruption) and distribution (an improvement of 3 percentage points of countries reporting no/low disruption).

Every year, programs supported by the Global Fund partnership save more than five million lives. Disruptions to these programs could have a catastrophic effect on the fight against HIV, TB and malaria. Recent modelling studies have shown that deaths from HIV, TB and malaria could as much as double in the coming years as a result of the COVID-19 pandemic, wiping out decades of hard-fought gains, unless we can urgently provide health workers with the training, resources and protective equipment they need to safely continue their work.

The Global Fund, the largest multilateral investor in grants for health systems worldwide, is providing immediate funding of up to US$1 billion to help countries fight COVID-19, mitigate the impact on lifesaving HIV, TB and malaria programs, and prevent fragile health systems from being overwhelmed. Countries and communities are devising new and innovative approaches to service delivery to enable them to be implemented safely, from virtual monitoring of TB treatment via smartphone apps, to dispensing multiple months of treatment to people with HIV and TB, and door-to-door delivery of critical supplies like mosquito nets.

Note on methodology: The biweekly survey is completed online by country-based Local Fund Agents (Global Fund service providers) who consolidate views of various in-country stakeholders, but the data are not verified. The tool helps identify potential risks and disruptions to programs, but is not intended to be a rigorous assessment of the country situation, nor should it be interpreted as such. A total of 106 countries completed the survey.