Covid-19 disrupts HIV and TB services

The Covid-19 pandemic has disrupted health services across South Africa, including life-saving treatment for tuberculosis (TB), HIV and non-communicable diseases that continue to plague the country.

The pandemic has forced the health sector to divert resources for other health needs to contain the spread of Covid-19. 

There has been a reduction in the number of diagnostic tests for TB, treatment and contact tracing as well as starting those near TB patients on prevention treatment. 

According to the 2020 World Health Organisation World TB Report, there’s been a large decline in the number of people with TB being detected and officially reported monthly from several high burden countries such as South Africa, India and the Philippines. 

In South Africa, health experts cautioned that people infected with TB may be more at risk of Covid-19 infections and this could also worsen their outcomes. Being infected with Covid-19  may also increase the risk of worsening the disease in people who were already infected with TB. 

We are very concerned to see that HIV testing fell by nearly half and that TB testing and primary health care access by carers and children fell by between 9% and 25%…

Minister of Health Zweli Mkhize

South Africa is one of the 78 countries that are on track to reach the 2020 milestone of a 20% decrease in new TB infections. 

“South Africa has been at the forefront of the fight against TB. They’ve been the first to introduce new treatment methods and also prioritising key populations such as the mining industry,” said Lucica Ditiu, the executive director of the Stop TB Partnership.
Ditiu was speaking at the Mineral Council of South Africa’s webinar on the effect of the pandemic on the health and wellbeing of workers. 

Although it’s too soon to properly assess how far-reaching the effect of Covid-19 is, it’s clear that migrant workers are disproportionately affected, said Paliani Chinguwo, the Southern Africa Trade Union Coordination Council’s research and information officer.
Migrant workers suffered from mental distress caused by not being able to travel home because of the restriction of movement during the lockdown, he added. Those with expired documentation couldn’t visit health facilities when they needed to because they were afraid of being detained or deported.  

But experts also argue that the pandemic could benefit TB and HIV services. The health interventions put in place for Covid-19 — such as screening, social grants, rapid follow-ups and contact tracing — could improve the efficiency of treatment for TB and HIV, according to a paper published recently in The Lancet.

“South Africa has had remarkable successes in the management of HIV and tuberculosis in the past 10 years but these gains are threatened by Covid-19,” the researchers wrote.

Modelling from July estimated the potential effect of the Covid-19 pandemic on

HIV, tuberculosis and malaria in low- and middle-income countries would be large. The researchers estimated that the deaths caused by HIV and TB and malaria over the next five years could rise by up to 10% and 20% respectively. 

“We are very concerned to see that HIV testing fell by nearly half and that TB testing and primary health care access by carers and children fell by between 9% and 25%,” Minister of Health Zweli Mkhize said.

“I am however pleased to inform all of you that the department of health has devised an aggressive catch-up strategy to ensure that we recapture that spirit of health-seeking behaviour and also capitalise on the infrastructure and public-private partnership gains we made during the Covid-19 surge.”

Mkhize said the department will be communicating the details of these programmes as and when they are rolled out. 

While it’s not clear what South Africa’s recovery plans for HIV and TB will be, experts say that increasing self-administered treatment, treatment literacy, using shorter regimens and scaling up counselling, screening and testing will be crucial in ensuring the world doesn’t lose its fight against these two diseases, especially in high burden countries. 



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