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Peer reviewedOpen accessTuberculosisSARSCOVID-19

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

International Journal of Infectious Diseases·

Jean B. Nachega, Nathan Kapata, Nadia A. Sam-Agudu, Eric H. Decloedt, Patrick D.M.C. Katoto, Tumaini Nagu, Peter Mwaba, Dorothy Yeboah-Manu, Pascalina Chanda-Kapata, Francine Ntoumi, Elvin H. Geng, Alimuddin Zumla

DOI
10.1016/j.ijid.2021.03.038
PMID
33757874
PMCID
PMC7980520
OpenAlex
W3138392825
Study type
Commentary
Publisher
Elsevier BV
Article type
journal-article
Integrity
current

Why this research matters now

The pandemic has strained health systems in sub-Saharan Africa that were already managing dual tuberculosis and HIV epidemics. Insufficient resources and gaps in case detection may contribute to undercounting of COVID-19 burden, complicating response efforts.

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Structured evidence summary

Research question

This perspective examines how the COVID-19 pandemic has affected tuberculosis and HIV health services in sub-Saharan Africa and explores strategies to reduce the combined burden of these three overlapping epidemics.

Study design

This is a perspective article that synthesizes modeling studies and limited empirical evidence to discuss the colliding epidemics in sub-Saharan Africa.

Population and setting

The focus is on sub-Saharan African countries, which report disproportionately high shares of global tuberculosis and HIV cases relative to Western nations.

Main findings

Modeling work suggests that pandemic-related interruptions to tuberculosis and HIV services may lead to substantial rises in illness and death over the following five years. Early empirical data indicate that co-infection with SARS-CoV-2, tuberculosis, and HIV may be linked to higher mortality risk in the region.

Public-health relevance

The pandemic has strained health systems in sub-Saharan Africa that were already managing dual tuberculosis and HIV epidemics. Insufficient resources and gaps in case detection may contribute to undercounting of COVID-19 burden, complicating response efforts.

Important limitations

Predictive models need stronger evidence to precisely characterize COVID-19's impact on communicable diseases like tuberculosis and HIV as well as on non-communicable comorbidities. Additional research is required to evaluate morbidity and mortality across age groups, geographic variation, and clinical and socioeconomic factors in the context of tuberculosis and HIV co-infection.

GIDS interpretation

This perspective was identified through classifier links to SARS, COVID-19, and tuberculosis disease categories and to transmission dynamics, treatment, and climate/environment topic areas, reflecting its relevance to intersecting infectious disease burdens in resource-limited settings.

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Related GIDS surveillance

Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.

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Evidence relationships

This article has 13 auditable classifier relationships to diseases, places, topics, and study design.

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