What does the COVID-19 pandemic mean for HIV, tuberculosis, and malaria control?
What does the COVID-19 pandemic mean for HIV, tuberculosis, and malaria control?
复制标题
DOI：
10.1186/s41182-020-00219-6
复制
发表时间：
2020-05-13
影响因子：
4.5
通讯作者：
Magit, Anthony
中科院分区：
文献类型：
--
作者：
Amimo, Floriano;Lambert, Ben;Magit, Anthony
尽管与其他地区相比，非洲目前的病例和死亡人数在全球所占比例相对较低，但2019年冠状病毒病（COVID-19）有可能在该地区引发其他更大的危机。这是由于卫生和经济系统的脆弱性，加上人体免疫缺陷病毒（艾滋病毒）、结核病和疟疾的沉重负担。在此，我们探讨COVID-19对非洲控制这些主要流行病的潜在影响。我们使用了从文献中检索到的关于艾滋病毒、结核病和疟疾疾病负担以及COVID-19在非洲的流行动态的现有证据。我们的分析表明，目前控制COVID-19的措施忽视了非洲重要而复杂的特定背景下的流行病学、社会和经济现实。结核病和疟疾的临床特征与用于追踪COVID-19病例的临床特征相似。再加上机构的不信任和错误信息，可能导致许多临床特征与COVID-19相似的患者不愿自愿到正规医疗机构寻求治疗。此外，非洲大多数处于生产年龄的人在非正规部门工作，而正规部门的大多数人就业不足。在目前控制COVID-19的措施下，这些人群在获得基本服务方面可能面临前所未有的困难，主要是由于患者支持直接和间接医疗费用的能力下降，以及无法获得前往卫生设施的交通工具。因此，如果不同时考虑到适当的经济和流行病因素，我们预计，这些措施可能导致社会弱势群体在获得基本服务方面遇到前所未有的困难，这些服务包括艾滋病毒和获得性免疫缺陷综合症患者获得抗逆转录病毒和预防药物、抗结核药物以及孕妇和儿童获得疟疾的治疗和预防治疗。这可能会增加患者服用低于标准剂量和/或药物的倾向，从而有可能损害药物疗效，并加剧本区域的健康不平等。国家层面的COVID-19应对措施应包括保护社会弱势群体和服务不足群体的措施。
Despite its current relatively low global share of cases and deaths in Africa compared to other regions, coronavirus disease 2019 (COVID-19) has the potential to trigger other larger crises in the region. This is due to the vulnerability of health and economic systems, coupled with the high burden of human immunodeficiency virus (HIV), tuberculosis (TB), and malaria. Here we examine the potential implications of COVID-19 on the control of these major epidemic diseases in Africa. We use current evidence on disease burden of HIV, TB, and malaria, and epidemic dynamics of COVID-19 in Africa, retrieved from the literature. Our analysis shows that the current measures to control COVID-19 neglect important and complex context-specific epidemiological, social, and economic realities in Africa. There is a similarity of clinical features of TB and malaria, with those used to track COVID-19 cases. This coupled with institutional mistrust and misinformation might result in many patients with clinical features similar to those of COVID-19 being hesitant to voluntarily seek care in a formal health facility. Furthermore, most people in productive age in Africa work in the informal sector, and most of those in the formal sector are underemployed. With the current measures to control COVID-19, these populations might face unprecedented difficulties to access essential services, mainly due to reduced ability of patients to support direct and indirect medical costs, and unavailability of transportation means to reach health facilities. Therefore, if not accompanied with appropriate economic and epidemiological considerations, we anticipate that these measures might result in unprecedented difficulties among vulnerable segments of society to access essential services, including antiretroviral and prophylactic drugs among people living with HIV and Acquired Immune Deficiency Syndrome, anti-tuberculosis drugs, and curative and preventive treatments for malaria among pregnant women and children. This might increase the propensity of patients taking substandard doses and/or medicines, which has the potential to compromise drug efficacy, and worsen health inequalities in the region. COVID-19 responses at country level should include measures to protect vulnerable and under-served segments of society.