Effects of Covid-19 and HIV

There are indications that the recent focus on how to contain the dreaded

Toyin Aderibigbe

Coronavirus disease (COVID-19) pandemic, which has ravaged the whole world, has disrupted detection and treatment of other infectious diseases. Medical experts have demonstrated how the novel coronavirus (COVID-19) pandemic has affected efforts to end the Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) in Nigeria and indeed the rest of the world by 2030. According to UNAIDS, deaths from HIV could almost double over the next year. The reason being the outbreak of Coronavirus pandemic (COVD-19).

It is a horrifying prospect, and calls for an urgent action plan. An editorial published in the journal Nature titled “How to stop COVID-19 fueling a resurgence of AIDS, malaria and tuberculosis” noted that more than three months of lockdowns have prevented many people from accessing treatment for non-COVID-19 infectious diseases. At the same time, new cases of these illnesses will have gone undetected.

If access to antiretroviral therapies is disrupted for just six months, this number is projected to double in the coming year. Although lockdowns are easing, it will take some time for health care to get back to normal, as authorities continue to prioritise COVID-19. Nigerian researchers have identified the impact of COVID-19 on HIV financing in the country and called for proactive measures.

The researchers, in the study published recently in the journal BMJ Global Health, said COVID-19, the most devastating pandemic since the 1918 influenza pandemic, has had severe health and economic impacts globally, including in Nigeria. Nigeria has the third largest HIV epidemic worldwide and despite the onset of COVID-19, efforts to control HIV continued vigorously. The researchers said HIV funding must be protected from the ongoing shocks to the Nigerian economy, so that Nigeria does not lose the gains achieved over the past decades. Bold proactive steps are needed, such as integrating HIV into the National Health Insurance Scheme, encouraging private sector contribution to HIV and building a robust health system. 

On the potential impact of COVID-19 on HIV funding, the authors said with the global and national economic effects of COVID-19, donor funding, domestic public financing and private out -of pocket spending for HIV could all be under threat. 

 In the short term, donors have responded to COVID-19 by mobilizing additional funding to respond to the pandemic, such as financing COVID-19 vaccine development efforts. However, in the face of post-COVID-19 austerity, official development assistance (ODA) could be one of the first spending item that gets cut. For example, the 2008 global financial crisis triggered a decline in flows of ODA to low and middle-income countries.

Nigeria is also seeing existing ODA flows to HIV being redirected to COVID-19. On April 4, 2020, the Global Fund released a Guidance Note allowing recipient countries to use HIV, TB and malaria grants to fight COVID-19 through reprogramming up to five per cent of savings under existing grants and spending underused funds.

The researchers said a fall in funding for Nigeria’s HIV response would have short and long-term consequences. Due to the global slowdown in drug production lines and the restriction of flights affecting logistics services, there might be a shortage of antiretroviral medicines (ARV). With the reduction in revenue and the weakened national currency (the naira), the government may not be able to raise sufficient funds to purchase ARVs.

Movement restrictions in country may result in challenges in delivering medicines and commodities to facilities. The researchers noted that at the level of the client, limited or reduced income due to the COVID-19 shock could lead to loss to follow-up. In Nigeria, though HIV drugs are free; clients still incur costs for registration, laboratory services and transportation, among others. Clients may default to avoid these costs.

With stock-outs and loss to follow-up, adherence is compromised and resistance to ARVs may develop. Achieving viral suppression in infected people helps reduce HIV transmission. With poor adherence, the risk of transmission rises, leading to increased new infections. The gradual rise in new HIV infections noted since 2016 may therefore worsen. 

According to the study, dedicated HIV funding has contributed partly to strengthening the Nigerian health system, for example, funding for prevention of vertical transmission of HIV/AIDS has been used to strengthen obstetric services. A decline or withdrawal of these funds would result in a weakening of the health system. The researchers urged Nigeria to take bold, proactive steps to ensure sustainability of HIV response, given the risks of HIV resurgence due to COVID-19 crisis.

Meanwhile all tiers of government should re-strategize and reinforce the national HIV response in face of the COVID-19 challenges, drawing from the six key recommendations by Nigerian researchers recently published in the journal BMJ Global Health. These include a proposal to integrate HIV into social health insurance scheme to create a sustainable funding pool and development of a national COVID-19 response plan to leverage on the existing health system and absolve shocks from COVID-19 impact. In addition, the researchers suggested increased advocacy to the political class, donors and the private sectors to ensure HIV issues remain on the front burner of the national agenda to help attract needed funding from domestic and external sources. Government is also urged to intensify efforts to building a robust health system with a expanded workforce.