COVID-19 caused ‘substantial disruption’ to HIV and TB services in South-East Asia

The first evidence review assessing the impact of COVID-19 on HIV and tuberculosis (TB) services in South-East Asia suggests the damage done by the pandemic is worse than previously estimated. 

What is the research about? 

The impact of the COVID-19 pandemic on infectious conditions, including HIV and TB, in South-East Asia. 

It is based on evidence from 12 studies conducted in Bhutan, Sri Lanka, Nepal, Myanmar, Thailand and India. Each study compared health services during COVID-19 with services provided in 2019 or earlier.  

Why is this research important? 

Until this evidence review, estimates of health service disruption caused by the COVID-19 pandemic have mainly come from the World Health Organization’s PULSE survey. PULSE reported that services for TB and HIV were moderately affected in South-East Asia. But this finding is based on a limited assessment. This evidence review gives a fuller picture.  

What did they find out? 

Evidence from India and Thailand suggests services for HIV screening, diagnosis and treatment initiation were highly disrupted. 

During Thailand’s first COVID-19 wave one study found an 80% reduction in people being screened for HIV, a 79% reduction in the number of people receiving an HIV-positive diagnosis and a 78% reduction in people starting antiretroviral treatment (ART), compared to pre-COVID levels. 

Just after the first wave ended the study found a 65% reduction in people screened for HIV, a 64% reduction in the number of people receiving an HIV-positive diagnosis and a 68.5% reduction in people starting ART, compared to pre-COVID levels. 

A study at an Indian hospital found the number of people tested for HIV fell by 57% in 2020 compared to the 2016-2019 annual average. HIV diagnoses fell by 54%. 

A study from Myanmar found condom distribution fell by 12% between 2019 and 2020.  

Evidence from India, Nepal and Indonesia suggests TB services were similarly disrupted. For example, a study at a Northern Indian hospital found 25% fewer TB tests were done in 2020 than in 2019. Despite this, more people tested positive for TB in 2020. It is likely that lockdown increased close contact amongst family members, which increased TB transmission. 

What does this mean for HIV services? 

If the number of people with undiagnosed HIV and TB has increased, a rise in HIV and TB infections is likely to follow. In time, there are likely to be more AIDS-related deaths. 

The need to ensure people with undiagnosed HIV are reached with testing and treatment has become even more pressing. Without a renewed focus on this, the region’s HIV epidemic could speed up considerably. 

As governments look to prepare for future pandemics, there is a need to advocate for plans that guarantee HIV and TB services continue or even increase during public health emergencies. HIV prevention and testing services should pay particular attention to the most vulnerable communities during these times, as these communities become even harder to reach during crises. Without such planning in place, future pandemics could lead to progress on HIV and TB going backwards even further.