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

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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.