The DOMINO Study: Measuring and mitigating the indirect effects of COVID-19 on TB and HIV care in Indonesia

据预测，COVID-19大流行对结核病和艾滋病毒卫生服务造成的破坏，如果持续六个月以上，将导致140万人死于结核病相关疾病，50多万人死于艾滋病毒（5,6）。如果正确的话，这些预测与十多年前全球艾滋病毒和结核病的死亡率相对应。印度尼西亚是世界上人口第四多的国家，是东南亚COVID-19感染病例最多的国家(2)。该国的结核病负担在全球排名第三(3)，也是为数不多的艾滋病毒新发感染人数不断增加的国家之一(4)。虽然印度尼西亚最近加强了控制这些疾病的努力，但将资源转移到流行病上，再加上保持社会距离的政策，正在为依赖结核病和艾滋病毒服务的人创造新的脆弱性，并加剧了现有的脆弱性。该国迫切需要了解这一流行病对结核病和艾滋病毒护理的更广泛影响，以便为缓解战略提供信息。我们将以现有的强大合作研究关系为基础，快速评估2019冠状病毒病疫情（以及应对政策）对印度尼西亚结核病和艾滋病毒治疗的提供和可及性的影响，特别强调高度脆弱的亚人群。我们的研究结果将用于制定战略，以保障在近期和中期对结核病和艾滋病毒患者的护理的连续性，从而确保该国不会失去其在控制这些疾病方面取得的重大进展。

The disruption to TB and HIV health services brought about by the COVID-19 pandemic, if sustained over six-months, has been predicted to result in 1.4 million extra deaths from TB-related illnesses and over 500,000 from HIV (5,6). If correct, these predictions correspond to deaths rates for HIV and TB last seen globally more than a decade ago. Indonesia, the fourth most populous country in the world, has the highest number of COVID-19 infection cases in Southeast Asia (2). The country is also ranked third for TB burden globally (3) and one of few countries with an increasing number of new HIV infections (4). While Indonesia has recently strengthened efforts to control these diseases, the diversion of resources to the pandemic combined with social distancing policies is creating new vulnerabilities and exacerbating existing ones for people who rely on TB and HIV services. The country urgently needs to understand the wider impact of the pandemic on TB and HIV care to inform mitigation strategies. We will build on strong, existing collaborative research relationships to rapidly assess the impact of the COVID-19 outbreak (and policy responses to it) on the delivery of and access to TB and HIV care in Indonesia, with a particular emphasis on highly vulnerable sub populations. Our findings will be used to design strategies to safeguard the continuity of care for TB and HIV patients in the near and medium term, thereby ensuring the country does not lose ground on the major advances it has made towards the control of these diseases.