The Covid-19 pandemic has significantly impacted detection, treatment, and control of HIV and TB globally. Resources and focus have shifted towards Covid-19 testing and treatment, leading to an estimated 300,000 missed TB cases in Nigeria alone. Lockdowns and fear of infection have also reduced rates of HIV and TB testing and treatment. Supply chain disruptions from China, where many generic drug manufacturers obtain raw materials, risk shortages of antiretroviral drugs. This could lead to increased HIV-related deaths, as treatment interruptions reactivate the virus and increase susceptibility to opportunistic infections like TB. Increased use of telemedicine, multi-month drug dispensing, and supply chain diversification are recommended to mitigate these
1. Impact of Covid-19 on detection,
infection and control of HIV and TB
A global perspective on how GVCs of testing and medication manufacturing and
supply have been adversely impacted.
2. Objectives of study
Highlight the impact of Covid-19 global public health focus to the detriment of other
infectious lethal diseases.
Highlight the need for increased community testing of HIV and TB alongside Covid-19 cases
for early detection, “test and treat approach”.
Examine key elements that may lead to scarcity of medication for HIV and TB.
Proffer solutions and risk mitigation strategies to combat a surge in these infectious
diseases.
3. Impact of Covid-19 on Global Community
Covid-19 has invariably become the largest public health global emergency currently being
faced the world over. With over 30 million cases and about 935,000 deaths as at September
12, it has exacerbated a wide range of challenges to the global public health system and the
global economy as a whole.
With the earliest cases detected and identified in Wuhan, China on December31, 2019 it
quickly spread like wildfire to all parts of the globe within a couple
months.
Being a novel highly infectious variant without cure, major economic global players
embarked on stringent lockdowns and economic shutdowns to curb the spread of the
disease.
The lockdowns are currently being eased to balance lives and livelihoods to restore some
semblance of normalcy as the race for a vaccine continues.
4. impact on Global Public Health Systems
Due to its highly infectious nature and rapid spread, it has stretched public health facilities
and staff in its entirety highlighting fragility of some systems as they have been
overstretched. Public health staff have also been part of the fatalities of this infectious
disease in all parts of the globe.
Countries with large populations such as the United States, India and Brazil are among the
worst-hit accounting for about 12 million infections as at September 12, 2020 with
cumulative deaths approaching 300,000 (www.who.int.org).
5. HIV and TB testing and treatment in 2020
The lockdowns imposes globally have adversely impacted movement, with HIV and TB
detection taking a back burner due to concentration of Covid-19 testing. Likewise, people
are afraid of visiting hospitals fearing getting infected with Covid-
19.
In the same vein, a vast number of patients on treatment are afraid of visiting hospitals for
their regular checkups due to fear of infection as their condition increases fatality
risk.
In Nigeria alone, which has a high TB burden, it is estimated that about 300,000 cases have
missed detection in 2020, with far reaching and lethal
consequences.
UNAIDS estimates that a six month disruption in HIV ART supply could lead to an
additional 500,000 deaths alone. This is quite worrisome to the global health practice and
system.
6. Effects of Covid-19 on GVCs of HIV and TB
medication
A study of eight generic manufacturers of HIV Antiretroviral therapy showed heavy reliance
on KSMs and APIs in China. These manufacturers are key suppliers to low and middle income
countries where prevalence of HIV and TB is quite high. Disruptions in procurement &
sourcing of active ingredients would invariably lead to shortage in supply of ART to low and
middle income countries (www.unaids.org).
The resultant effect is hospitals running out of ART while would exacerbate and accelerate
HIV to AIDS and susceptibility to opportunistic infections such as Tuberculosis which is a
major leading cause of AIDS related deaths especially in Sub-Saharan Africa.
7. Major Challenges
High dependence of generic manufacturers on China for Key Supply Materials (KSM) and
Active Pharmaceutical Ingredients (API).
Lag times in form of shipping delays and inland road infrastructure networks due to
backlogs.
Factories operating at far less than optimal capacity due to the need for social distancing at
factories.
Stigmatization susceptibility leading to avoidance of testing and diagnosing cases till it
might be ‘too little too late’ to act.
8. Conclusion
Covid-19 has invariably altered every facet of human society as we know it.
Physical and social distancing rules make operating at optimal capacity almost impossible
due to lower staff strength.
It has exposed the fragility of public health systems all over the globe but most especially in
Lower and middle income countries.
It has exposed the gaps in Global Value Chains of public health systems most especially those
producing generic drugs.
9. Recommendations
The adoption of multi-month dispensing (3-6 months) of drugs for HIV and TB patients to
reduce hospital visitations
Adoption of innovative technologies via use of telemedicine (virtual consultations via
computers with doctors)
Rejigging the Global value chains of global manufacturers to to adopt keeping buffer stock
of key supply materials (KSM) and active pharmaceutical ingredients (API) to cater for
unforeseen circumstances such as lockdowns.
10. REFERENCES
Bharat, B.R. et. al. (rewarib@who.int) March 2020
www.who.int (accessed September 18, 2020)
Toyin T., Annals of Clinical Microbiology and Antimicrobials 19, Article number 21 (2020)
www.unaids.org (accessed September 13, 2020)
www.aidsmap.org (accessed September 15, 2020)
COVID-19 and TB: frequently Asked Questions. https://www.theunion.org/news-centre/covid-
19/covid-tb-faqs. Accessed September 14, 2020
