Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study.
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Hogan Alexandra B, Jewell Britta L, Sherrard-Smith Ellie, Vesga Juan F, Watson Oliver J, Whittaker Charles, Hamlet Arran, Smith Jennifer A, Winskill Peter, Verity Robert, Baguelin Marc, Lees John A, Whittles Lilith K, Ainslie Kylie E C, Bhatt Samir, Boonyasiri Adhiratha, Brazeau Nicholas F, Cattarino Lorenzo, Cooper Laura V, Coupland Helen, Cuomo-Dannenburg Gina, Dighe Amy, Djaafara Bimandra A, Donnelly Christl A, Eaton Jeff W, van Elsland Sabine L, FitzJohn Richard G, Fu Han, Gaythorpe Katy A M, Green William, Haw David J, Hayes Sarah, Hinsley Wes, Imai Natsuko, Laydon Daniel J, Mangal Tara D, Mellan Thomas A, Mishra Swapnil, Nedjati-Gilani Gemma, Parag Kris V, Thompson Hayley A, Unwin H Juliette T, Vollmer Michaela A C, Walters Caroline E, Wang Haowei, Wang Yuanrong, Xi Xiaoyue, Ferguson Neil M, Okell Lucy C, Churcher Thomas S, Arinaminpathy Nimalan, Ghani Azra C, Walker Patrick G T, Hallett Timothy B
Аннотация
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.