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

新冠肺炎大流行对结核病和艾滋病毒卫生服务造成的干扰，如果持续6个月以上，预计将导致额外140万人死于结核病相关疾病，50多万人死于艾滋病毒(5，6)。如果预测正确，这些预测与十多年前全球上一次看到的艾滋病毒和结核病死亡率相对应。印尼是世界第四人口大国，也是东南亚新冠肺炎感染病例最多的国家(2)。该国也在全球结核病负担方面排名第三(3)，并且是少数几个新增艾滋病毒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，但将资源转移到大流行加上社会疏远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，并加剧现有的脆弱性。该国迫切需要了解大流行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。我们将在现有牢固的合作研究关系的基础上，快速评估新冠肺炎疫情对印度尼西亚结核病和艾滋病毒护理的提供和获得的影响(以及对此采取的政策应对措施)，特别重视高度脆弱的亚人群。我们的研究结果将被用来设计战略，以保障在近期和中期内对结核病和艾滋病毒患者的持续护理，从而确保该国在控制这些疾病方面取得的重大进展不会失利。

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.