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最大限度地减少 COVID-19、结核病和艾滋病毒三重负担对撒哈拉以南非洲卫生服务的影响。

Minimizing the impact of the triple burden of COVID-19, tuberculosis and HIV on health services in sub-Saharan Africa.

机构信息

Department of Medicine and Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa; Department of Epidemiology, Infectious Diseases and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.

Zambia National Public Health Institute, University of Zambia-University College London Medical School Research and Training Project, University Teaching Hospital, Ministry of Health, Lusaka, Zambia.

出版信息

Int J Infect Dis. 2021 Dec;113 Suppl 1:S16-S21. doi: 10.1016/j.ijid.2021.03.038. Epub 2021 Mar 20.


DOI:10.1016/j.ijid.2021.03.038
PMID:33757874
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7980520/
Abstract

In this perspective, we discuss the impact of COVID-19 on tuberculosis (TB)/HIV health services and approaches to mitigating the growing burden of these three colliding epidemics in sub-Saharan Africa (SSA). SSA countries bear significantly high proportions of TB and HIV cases reported worldwide, compared to countries in the West. Whilst COVID-19 epidemiology appears to vary across Africa, most countries in this region have reported relatively lower-case counts compared to the West. Nevertheless, the COVID-19 pandemic has added an additional burden to already overstretched health systems in SSA, which, among other things, have been focused on the longstanding dual epidemics of TB and HIV. As with these dual epidemics, inadequate resources and poor case identification and reporting may be contributing to underestimations of the COVID-19 case burden in SSA. Modelling studies predict that the pandemic-related disruptions in TB and HIV services will result in significant increases in associated morbidity and mortality over the next five years. Furthermore, limited empirical evidence suggests that SARS-CoV-2 coinfections with TB and HIV are associated with increased mortality risk in SSA. However, predictive models require a better evidence-base to accurately define the impact of COVID-19, not only on communicable diseases such as TB and HIV, but on non-communicable disease comorbidities. Further research is needed to assess morbidity and mortality data among both adults and children across the African continent, paying attention to geographic disparities, as well as the clinical and socio-economic determinants of COVID-19 in the setting of TB and/or HIV.

摘要

在这篇观点文章中,我们讨论了 COVID-19 对结核病(TB)/艾滋病毒健康服务的影响,以及在撒哈拉以南非洲(SSA)地区减轻这三种同时发生的流行病日益加重的负担的方法。与西方国家相比,SSA 国家在全球报告的结核病和艾滋病毒病例中占比显著更高。虽然 COVID-19 的流行病学在非洲各地似乎有所不同,但该地区的大多数国家报告的病例数相对较少。然而,COVID-19 大流行给 SSA 已经不堪重负的卫生系统增加了额外的负担,这些系统除其他外,一直专注于结核病和艾滋病毒这两种长期存在的双重流行病。与这两种流行病一样,资源不足和病例识别与报告不佳可能导致对 SSA COVID-19 病例负担的低估。模型研究预测,与大流行相关的结核病和艾滋病毒服务中断将导致未来五年相关发病率和死亡率的显著增加。此外,有限的经验证据表明,SARS-CoV-2 与结核病和艾滋病毒的合并感染与 SSA 中的死亡风险增加相关。然而,预测模型需要更好的证据基础来准确定义 COVID-19 的影响,不仅对结核病和艾滋病毒等传染病,而且对非传染性疾病合并症也是如此。需要进一步研究来评估整个非洲大陆的成年人和儿童的发病率和死亡率数据,注意地理差异,以及结核病和/或艾滋病毒环境中 COVID-19 的临床和社会经济决定因素。

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[9]
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