Mitigating the impact of COVID 19 on tuberculosis and HIV services: a cross sectional survey of 669 health professionals in 64 low and middle income countries
Background The disruption of essential services for infectious diseases such as tuberculosis (TB) and HIV is likely to result in the indirect health impacts of COVID 19 being even greater than the direct impacts. The experiences of frontline health professionals are invaluable in understanding how to minimise disruption of healthcare services during emergency situations, but are insufficiently incorporated into policy planning. We synthesised information from frontline TB and HIV professionals to identify ways in which COVID 19 has affected services in low and middle income countries (LMIC) and strategies to minimise impacts on patients and healthcare providers. Methods We conducted a cross sectional study of TB and HIV healthcare delivery, management, and research professionals in LMIC around the world. Between May 12 and August 6 2020, we collected qualitative and quantitative data using an online survey disseminated through professional networks and social media in 11 languages. We used descriptive statistics and thematic analysis to analyse responses. Results 669 respondents from 64 countries completed the survey, representing a 72% response rate. Over 40% of respondents stated that it was impossible or much harder for TB and HIV patients to reach healthcare facilities since COVID 19. The most common barriers reported to affect patient utilisation of healthcare facilities were: fear of getting infected with SARS CoV 2, transport disruptions, movement restrictions, and reduced income. Healthcare provider access to healthcare facilities was also severely impacted according to 37% of TB respondents and 28% of HIV respondents. In line with this finding, qualitative responses focused on strategies to facilitate transport of patients and healthcare providers or service delivery adaptations to reduce the need for patients to travel to healthcare facilities. While only 16% and 11% of respondents reported major disruptions to provision of medical treatment for HIV or TB, access to non medical support for patients, such as food supplementation or counselling, was harder or impossible to access according to 35% and 31% of HIV and TB respondents respectively. Our qualitative data suggested that nutritional support became critical for some patients when movement restrictions and employment instability reduced access to income and food. Discussion Our large multi country survey indicated that patients and healthcare providers across numerous LMIC faced substantial challenges in accessing healthcare facilities, and that critical non medical support for patients, such as food supplementation and counselling, was particularly impacted by COVID 19 disruptions. Frontline professionals identified important policies and healthcare service delivery adaptations that could mitigate disruptions in the future. It is essential to facilitate sharing of their experiences with policymakers and healthcare service delivery organisations.
medRxiv