The latest survey results of Global Fund-supported programs across 106 countries show widespread disruptions to HIV, TB and malaria service delivery as a result of the COVID-19 pandemic, impacting approximately three-quarters of HIV, TB and malaria programs.
The results of this qualitative survey indicate challenges to HIV prevention; testing and case finding for HIV, TB and malaria; cancelled or delayed prevention activities; and medical and laboratory staff being reassigned to the fight against COVID-19. Key results from the latest survey, completed 1 June:
85% of HIV programs reported disruption to service delivery (18% with high or very high disruptions);
78% of TB programs reported disruption to service delivery (17% with high or very high disruptions);
73% of malaria programs reported disruption to service delivery (19% with high or very high disruptions).
Countries in Latin America and the Caribbean and high-burden countries in Africa report the highest levels of disruptions to implementation.
Twenty percent of HIV and TB lab services are experiencing high or very high disruptions; if people aren’t diagnosed, they can’t be put on treatment, and could continue to infect others. For example, a person with active TB can infect 10-15 other people in a year.
While the survey suggests supply chains are largely functioning, 10% of HIV, 9% of TB and 6% of malaria programs report shortages of key medical supplies and treatment. An increasing number of countries report disruptions to their routine reporting systems, making it more challenging to monitor progress.
Qualitative data from the survey indicates lockdowns, restriction on gatherings of people and transport stoppages are the main reasons activities have been cancelled or delayed. Additional causes of disruption include COVID-related stigma and reluctance of health workers to attend to people suspected of having TB or malaria – which have many of the same initial symptoms as COVID-19; and clients not seeking health services as usual, resulting from fear of getting infected with COVID-19 as well as economic hardships caused by the pandemic.
“We have seen similar effects before in Ebola outbreaks, and we know that if lifesaving HIV, TB and malaria programs are interrupted, additional deaths from those diseases could well outstrip the deaths from COVID-19 itself,” said Peter Sands, Executive Director of the Global Fund.
Every year, programs supported by the Global Fund partnership save more than five million lives. Disruptions to these programs could have a catastrophic effect on the fight against HIV, TB and malaria. Recent modelling studies have shown that deaths from HIV, TB and malaria could as much as double in the coming years as a result of the COVID-19 pandemic, wiping out many years of hard-fought gains, unless we can urgently provide health workers with the training, resources and protective equipment they need to safely continue their work.
The Global Fund, the largest multilateral funder of grants for health systems worldwide, is providing immediate funding of up to US$1 billion to help countries fight COVID-19, mitigate the impact on lifesaving HIV, TB and malaria programs, and prevent fragile health systems from being overwhelmed. Countries and communities are devising new and innovative approaches to service delivery to enable them to be implemented safely, from virtual monitoring of TB treatment via smartphone apps, to dispensing multiple months of treatment to people with HIV and TB, and door-to-door delivery of critical supplies like mosquito nets.
“The COVID-19 pandemic is only now starting to accelerate in many low- and middle-income countries, and needs will soar,” said Sands. “We expect that our initial funding will be largely deployed by the end of June. Additional funding is critically needed to fight COVID-19, and to adapt HIV, TB and malaria programs. If not, many more lives will be lost.”
Note on methodology: The biweekly survey is completed online by country-based Local Fund Agents who monitor grant implementation and progress on behalf of the Global Fund. The tool helps identify potential risks and disruptions to programs, but given its qualitative nature, is not intended to be a rigorous assessment of the country situation, nor should it be interpreted as such. The information is based on a range in-country stakeholder views but is not verified or calibrated. A total of 106 countries completed the survey.