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Pandemic response
COVID-19 is impacting communities around the world. PATH and our partners are responding.

Creative solutions as COVID-19 threatens progress against HIV, TB, and malaria

May 13, 2020 by Kelly Huffman

From India to Senegal and beyond, PATH leaders reflect on losing ground in the time of COVID-19—and creative ways we can partner to regain it.

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Infectious disease doctors prepare to travel to a prison in Dnipropetrovska oblast, Ukraine, where they will treat inmates living with HIV. Photo: 100 Percent Life -Dnipro/Olena Bilko

The United Nations’ Sustainable Development Goal 3 calls for the eradication of HIV, tuberculosis (TB), and malaria by 2030. But leaders formulated those goals long before the rise of COVID-19. Today, the pandemic threatens our collective progress against these persistent killers.

How is PATH responding? From India to Senegal and beyond, we spoke with our health care experts to learn about both the difficulties and the creative ways in which we’re partnering to sustain progress in the time of COVID-19.

Tuberculosis: leveraging expertise in infection control

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A staff member in Maharashtra, India facilitates digitization and provides counseling for symptomatic patients and their contacts. Photo: PATH.

India has the highest burden of TB in the world, and has vowed to eliminate the disease over the next five years. But when the country went into lockdown, most private clinics—typically a TB patient’s first point of contact—halted services. Fewer places to seek care could trigger an upsurge in TB transmission, says Dr. Shibu Vijayan, PATH’s global TB technical director.

With health workers diverted to the COVID-19 response, TB detection services are hampered. Daily case notifications across India have dropped from an average of 12,000 to just 2,000 since early March. It’s a troubling trend. “If it remains for another three months, that will significantly deter India’s plan to eliminate TB by 2025,” warns Dr. Vijayan.

Modelling by the Stop TB Partnership predicts an additional 6.3 million cases of TB over the next five years, and an additional 1.4 million TB deaths in the same period—a setback of five to eight years in the fight against TB.

PATH staff across India have mobilized a broad COVID-19 response while maintaining a focus on TB, including a call center to maintain virtual contact with quarantined TB patients. Our TB case workers are experts in infection control, contact tracing, and other public health measures that continue in the time of COVID-19.

Dr. Vijayan sees opportunity in the midst of pandemic: “Now is the time,” he says, “to transition our thinking from disease-specific verticals to basic public health system strengthening efforts.”

HIV: working to ensure continuity of care

Infectious disease specialist Valentyna Lazarev initiates antiretroviral therapy with a newly diagnosed HIV-positive individual in a Ukrainian prison. Photo: 100 Percent Life/Oleksandr Kaminskyi

Infectious disease specialist Valentyna Lazarev initiates antiretroviral therapy with a newly diagnosed HIV-positive individual in a Ukrainian prison. Photo: 100 Percent Life/Oleksandr Kaminskyi

“One of the biggest worries I have is the disruption of antiretroviral therapy for people living with HIV,” says Dr. Kimberly Green, PATH’s Vietnam-based global director for HIV and tuberculosis. “When lockdowns occurred in Kenya, Ukraine, and Vietnam, we saw people quarantined or separated from their multi-month supply of medication, clinics repurposed for the COVID-19 response, and a dramatic drop in HIV testing.”

With access to overall health care reduced during the pandemic, lockdowns and physical distancing expose already-marginalized populations to a host of other threats: intimate partner violence, catastrophic income loss, homelessness, and chronic anxiety among them. Recent modeling from Imperial College London estimates an increase in deaths due to COVID-19 among people living with HIV and TB over the next five years.

To best ensure continuity of care for those most at risk, PATH is responding on three fronts:

  • Protect: Equipping and training frontline health care providers to deliver essential services and triage people with COVID-19 exposure or symptoms; and assessing for and responding to intimate partner violence, socioeconomic harms, and mental health morbidity.
  • Mitigate: Rapidly adapting HIV and TB service delivery to ensure continuity of services while addressing exacerbated gender inequities.
  • Support: Utilizing existing services and projects to support national COVID-19 responses where needed, while not jeopardizing core HIV and TB services.

What makes this work possible? Strong existing partnerships and responsive funders. “I'm grateful that our donors and partners have been so fast to provide clear, pragmatic, and humane guidance,” says Dr. Green.

Turning malaria tools against COVID-19 in Senegal

Dominique Mami Bindia is one of PATH Senegal's malaria community champions in Tambacounda, where the team is now turning its awareness-raising skills to the country's COVID-19 response. Photo: PATH/Aminatou Sar.

Dominique Mami Bindia is one of PATH Senegal's malaria community champions in Tambacounda, where the team is now turning its awareness-raising skills to the country's COVID-19 response. Photo: PATH/Aminatou Sar.

“In Senegal, we’ve seen tremendous progress against malaria in the north,” says Aminatou (Ami) Sar, PATH’s program director for Senegal. “But our activities are down because now is not a time to gather people and do awareness-raising.” Health workers have halted home visits and bednet distribution as they turn their attention to COVID-19.

The pandemic has also highlighted shortages in basic health equipment across the country: gloves, gowns, handwashing equipment, intensive-care beds, oxygen, respirators. “It’s not just France, Spain, and the US,” says Ms. Sar. “Imagine how much more difficult it is in countries where the health system is already struggling.”

But she also points to the Senegal malaria team’s expertise in case management, investigation, and rapid response. They are leveraging their skills to help the Ministry of Health develop procedures—such as safety protocols for handling and transporting test samples—and training more health workers. Ms. Sar reports that her team is also looking into developing data visualizations to better deploy contact tracing efforts.

The Senegal malaria team relies on a digital health information system that’s highly effective at pinpointing malaria hotspots and mobilizing response. Now, the digital health staff has adapted the malaria-tracking tool to monitor and manage COVID-19 cases. “With the tracker,” says Ms. Sar, “we are turning our malaria staff deployed in the field into COVID-19 awareness-raising champions and data collectors.”

A call for solidarity

For Ms. Sar, the pandemic is a reminder of how closely the world is connected. “No one could suspect that a virus that originated in China could shake the world, that it could end up in the Tambacounda Region,” she says. (Tambacounda, some 500 kilometers from Dakar, had seen 64 COVID-19 cases as of April 30.)

The Senegal leader considers COVID-19 a wakeup call: It’s time for the world to show solidarity in the face of health inequity. Whether it’s malaria, TB, HIV, or another life-threatening illness, leaders must step up, she says. Not just with financial support, but a commitment to sharing equipment, strengthening health systems, accelerating knowledge, and implementing technology. “Even one death is not acceptable,” says Ms. Sar. “We have the resources and means. Now we need to have the courage to make the right decisions for people.”

Join us on 5/27 for the next PATH Live Forum, "Continuing essential HIV, tuberculosis, and malaria service delivery in a pandemic"
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