COVID-19 大流行对中低收入国家中艾滋病毒、结核病和疟疾的潜在影响：建模研究。
Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study.
机构信息
Medical Research Council Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK.
Medical Research Council Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK; Department of Statistics, University of Oxford, Oxford, UK.
出版信息
Lancet Glob Health. 2020 Sep;8(9):e1132-e1141. doi: 10.1016/S2214-109X(20)30288-6. Epub 2020 Jul 13.
BACKGROUND
COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years.
METHODS
Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic.
FINDINGS
In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics.
INTERPRETATION
Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic.
FUNDING
Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.
背景
由于病例使卫生系统不堪重负或应对措施限制了常规项目活动，COVID-19 有可能对卫生服务造成重大干扰。我们旨在量化在这些疾病负担沉重的低收入和中等收入国家中，服务中断对艾滋病毒、结核病和疟疾的影响，以及在未来 5 年内可能导致的额外生命损失。
方法
我们假设基本繁殖数为 3.0，构建了针对 COVID-19 大流行的四种可能应对方案的情景：不采取行动、缓解 6 个月、抑制 2 个月或抑制 1 年。我们使用已建立的艾滋病毒、结核病和疟疾传播模型来估计在选定的环境中，由于 COVID-19 干预措施限制了活动，或者由于 COVID-19 大流行对卫生系统的高需求，可能对卫生造成的额外影响。
发现
在高负担地区，与没有 COVID-19 大流行相比，5 年内艾滋病毒、结核病和疟疾导致的死亡人数可能分别增加 10%、20%和 36%。对艾滋病毒的最大影响估计来自中断抗逆转录病毒治疗，这可能发生在卫生系统需求高的时期。对于结核病，最大的影响将来自新病例及时诊断和治疗的减少，这可能是由于任何长时间的 COVID-19 抑制干预措施导致的。疟疾负担最大的影响可能是由于计划中的蚊帐运动中断。这些干扰可能导致 5 年内失去生命年数，其规模与疟疾负担高且艾滋病毒和结核病流行较大的地方的 COVID-19 直接影响相当。
解释
维持艾滋病毒、结核病和疟疾最关键的预防活动和医疗服务可以大大减轻 COVID-19 大流行的总体影响。
资助
比尔和梅琳达·盖茨基金会、惠康信托基金、英国国际发展部和医学研究理事会。
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