Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study
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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DOI：
10.1016/s2214-109x(20)30288-6
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发表时间：
2020-09-01
影响因子：
34.3
通讯作者：
Hallett, Timothy B.
中科院分区：
文献类型：
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作者：
Hogan, Alexandra B.;Jewell, Britta L.;Hallett, Timothy B.
背景COVID-19有可能对卫生服务造成重大干扰，原因是病例使卫生系统负担过重或应对措施限制了常规项目活动。我们的目标是量化在艾滋病、结核病和疟疾负担沉重的低收入和中等收入国家，这些疾病的服务中断在未来5年可能导致额外生命损失的程度。方法假设基本生殖数为3. 0，我们构建了四种可能应对COVID-19大流行的情景：不采取行动、缓解6个月、抑制2个月或抑制1年。我们使用已建立的艾滋病毒、结核病和疟疾传播模型，估计在选定环境中可能对健康造成的额外影响，这些影响可能是由于COVID-19干预措施限制了活动，也可能是由于COVID-19大流行对卫生系统的高需求。发现在高负担环境中，5年内因艾滋病毒、结核病和疟疾死亡的人数可能增加10%，与没有COVID-19疫情的情况相比，分别为20%和36%。据估计，对艾滋病毒的最大影响来自抗逆转录病毒疗法的中断，这可能发生在卫生系统需求高的时期。对于结核病，最大的影响将来自新病例的及时诊断和治疗的减少，这可能是由于任何长期的COVID-19抑制干预措施。对疟疾负担的最大影响可能是计划的蚊帐运动中断。这些干扰可能导致5年以上的生命年损失，与2019冠状病毒病在疟疾高负担以及艾滋病毒和结核病大流行地区的直接影响具有相同的数量级。解释维持针对艾滋病毒、结核病和疟疾的最关键预防活动和医疗保健服务可以大幅降低2019冠状病毒病大流行的整体影响。版权所有（C）2020作者。爱思唯尔有限公司出版
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. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.