Impact of COVID-19 pandemic and anti-pandemic measures on tuberculosis, viral hepatitis, HIV/AIDS and malaria – a systematic review

  1. Barbora Kessel
  2. Torben Heinsohn
  3. Jördis J Ott
  4. Jutta Wolff
  5. Max J Hassenstein
  6. Berit Lange

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Abstract

COVID-19 pandemic puts an enormous strain on health care systems worldwide and may have a detrimental effect on prevention, treatment and outcomes of tuberculosis (TB), viral hepatitis, HIV/AIDS and malaria, whose ending is part of the United Nations 2030 Agenda for Sustainable Development. We conducted a systematic review of scientific and grey literature in order to collect wide-ranging evidence with emphasis on quantification of the projected and actual indirect impacts of COVID-19 on the four infectious diseases with a global focus. We followed PRISMA guidelines and the protocol registered for malaria (CRD42021234974). We searched PubMed, Scopus, preView (last search: January 13, 2021) and websites of main (medical) societies and leading NGOs related to each of the four considered infectious diseases. The identified modelling studies warned about under-diagnosis (TB), anti-retroviral therapy interruption/decrease in viral load suppression (HIV), disruptions of insecticide-treated nets (ITN) distribution and access to effective treatment (malaria), and treatment delays and vaccination interruptions (viral hepatitis). The reported disruptions were very heterogeneous both between and within countries. If observed at several points in time, the initial drops (partly dramatic, e.g. TB notifications/cases, or HIV testing volumes decreased up to -80%) were followed by a gradual recovery. However, the often-missing assessment of the changes against the usual pre-pandemic fluctuations hampered the interpretation of less severe ones. Given the recurring waves of the pandemic and the unknown mid- to long-term effects of adaptation and normalisation, the real consequences for the fight against leading infectious diseases will only manifest over the coming years.

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  1. ScreenIT

    SciScore for 10.1101/2022.02.10.22270782: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    2.1 SSearch strategy and selection criteria: We searched PubMed, Scopus and preView for COVID-19 or SARS-CoV-2 and at least one of hepatitis, tuberculosis, HIV, or malaria (last search date: January 13, 2021), without language restrictions.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    For graphical presentation, we use simple line graphs (package ggplot2 [23] in R) and forest plots (package forestplot [24] in R).
    ggplot2
    suggested: (ggplot2, RRID:SCR_014601)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Besides re-allocation of staff, viral hepatitis and HIV services suffered from a reduction in face-to-face counselling as a consequence of applying physical distancing measures requiring, e.g., limitation of capacity [68, 75]. The fear of acquiring SARS-CoV-2 in hospital settings was a near-universal contributor to a decline in service usage and healthcare-seeking behaviour, with 50% of hepatitis appointments cancelled by patients [103]. Additionally, for TB, due to the overlap of symptoms, this was aggravated by the fear of being diagnosed with SARS-CoV-2 instead of TB, which in many countries carried a heavy stigma. Nevertheless, data on suspected cases from Africa [99, 111] shows that health-seeking behaviour was impacted more for less severe cases and that inequalities are reflected in the data [32] showing a greater reduction in attendance for children than adults, and for women than men. Regarding malaria, some local reports identified the fear of SARS-CoV-2 as problematic and described active counter-measures [125, 130]. In the case of HIV, restrictions in transportation and movement were another reason impeding service usage in some areas [58, 65]. For viral hepatitis, the heterogeneity in findings was also linked to the origin of survey participants and centre location [122]. Replies from low-income countries particularly alluded to people identified with viral hepatitis not being referred to care or further medically investigated, or that treatment shortages had led...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.02.10.22270782 on medRxiv