COVID- Africa: the cost of inaction



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There are many different reasons that could cause service disruption: This modeling exercise makes it clear that communities and partners must take action now, as the impact of a six-month interruption of antiretroviral therapy could effectively tick the clock. of AIDS-related deaths. Since 2008, when more than 950,000 AIDS-related deaths were observed in the region. And people would continue to die from the outage in large numbers for at least another five years, with an average annual excess death toll of 40% for the next half decade. Furthermore, interruptions in HIV service could also have some impact on HIV incidence in the coming year.

“The terrible possibility that half a million more people in Africa will die of AIDS-related diseases is like stepping back in history,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

“We must read this as a wake-up call to countries to identify ways to maintain all vital health services. For HIV, some countries are already taking important steps, for example, ensuring that people can collect bulk treatment packages and other essential products, including self-assessment kits, from delivery points, easing the pressure on services health and the health workforce. We must also ensure that global supplies of tests and treatments continue to flow to countries that need them, “added Dr. Tedros.

In sub-Saharan Africa, an estimated 25.7 million people were living with HIV and 16.4 million (64%) were taking antiretroviral therapy in 2018. Those people are now at risk of discontinuing their treatment because HIV services are closed or unable to provide therapy. antiretroviral because of disruptions in the supply chain or because services are simply overwhelmed due to competitive needs to support the COVID-19 response.

“The COVID-19 pandemic should not be an excuse to divert investment from HIV,” said Winnie Byanyima, Executive Director of UNAIDS. “There is a risk that the hard-earned gains from the AIDS response will be sacrificed in the fight against COVID-19, but the right to health means that no one disease must be fought at the expense of the other.”

In sub-Saharan Africa, an estimated 25.7 million people were living with HIV and 16.4 million (64%) were taking antiretroviral therapy in 2018

When treatment is complete, a person’s HIV viral load falls to an undetectable level, keeping them healthy and preventing transmission of the virus. When a person is unable to take antiretroviral therapy regularly, the viral load increases, which affects the person’s health, which can ultimately lead to death. Even short-term treatment interruptions can have a significant negative impact on a person’s health and potential for HIV transmission.

This research brought together five teams of modelers using different mathematical models to analyze the effects of various possible interruptions in HIV testing, prevention, and treatment services caused by COVID-19.

Each model analyzed the potential impact of three-month or six-month treatment interruptions on AIDS mortality and HIV incidence in sub-Saharan Africa. In the six-month outage scenario, estimates of excess AIDS-related deaths in one year ranged from 471,000 to 673,000, making it inevitable that the world will miss the 2020 global target of less than 500,000 related deaths. with AIDS worldwide.

Interruptions shorter than three months would see a reduced but still significant impact on HIV deaths. More sporadic interruptions in the provision of antiretroviral therapy would lead to sporadic adherence to treatment, leading to the spread of resistance to HIV drugs, with long-term consequences for the future success of treatment in the region.

Disrupted services could also reverse progress made in preventing mother-to-child transmission of HIV. Since 2010, new HIV infections in children in sub-Saharan Africa have decreased by 43%, from 250,000 in 2010 to 140,000 in 2018, due to the high coverage of HIV services for mothers and their children in the region. Reducing these services by COVID-19 for six months could see new childhood HIV infections rise dramatically, by up to 37% in Mozambique, 78% in Malawi, 78% in Zimbabwe, and 104% in Uganda.

Other significant effects of the COVID-19 pandemic on the AIDS response in sub-Saharan Africa that could lead to additional mortality include low-quality clinical care because health centers are overstretching and a suspension of load testing Viral, reduced adherence counseling and medication regimen changes. Each model also considered to what extent an interruption of prevention services, including suspension of voluntary male medical circumcision, interruption of condom availability and suspension of HIV testing, would affect HIV incidence in the region.

The research highlights the need for urgent efforts to ensure the continuity of HIV prevention and treatment services in order to avoid excess HIV-related deaths and avoid increases in HIV incidence during the COVID-19 pandemic. . It will be important for countries to prioritize underpinning supply chains and ensure that people already on treatment can continue treatment, including through the adoption or strengthening of policies such as the delivery of multi-month antiretroviral therapy to reduce access requirements to health care facilities. for routine maintenance, reducing the burden on overwhelming healthcare systems.

“Every death is a tragedy,” added Ms. Byanyima. “We cannot sit down and allow hundreds of thousands of people, many of them young, to die unnecessary deaths. I urge governments to ensure that all men, women and children living with HIV receive regular supplies of antiretroviral therapy, something that literally saves lives. “

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