KARACHI: A recent survey conducted to measure the impact of Covid-19 outbreak on tuberculosis and HIV services in 64 low- and middle-income countries, including Pakistan, has shown that restrictions on movement seriously impeded access to health facilities not only for patients, but also for healthcare providers needed to deliver services.

The survey was carried out by a multinational team, which included three Pakistani scientists, from May to August this year.

According to its findings, over 40 per cent of respondents said it was impossible or much harder for TB and HIV patients to reach healthcare facilities since Covid-19 began. Similarly, according to 37 per cent respondents, it was much harder or impossible for TB healthcare providers to reach their place of work.

Challenges were also reported in relation to HIV healthcare providers reaching their place of work, but these were not considered as severe as for HIV patients.

Although the study focused on provision of medical services (diagnosis and treatment), over 70 per cent of respondents reported that important nutritional or mental health support services for patients were impacted by Covid-19 outbreak.

A total of 669 TB and HIV professionals, including doctors, nurses, community healthcare providers, policymakers, laboratory technicians, health facility managers and researchers, participated in the survey.


The most common barriers affecting access to healthcare facilities were: fear of getting infected with Covid-19, transport disruptions and movement restrictions owing to lockdowns and reduced income.

The study also highlighted increased stigmatisation of HIV and TB patients owing to changes in the delivery of health services.

Examples provided by respondents included stigmatisation when HIV patients were asked to show health cards in order to travel, when patients presenting with TB symptoms were first isolated and tested for Covid-19, and when attention is drawn to HIV or TB patients in their neighbourhoods during community-based distribution of medicines.

It also reported the stigma about Covid-19 as there was increased concern among people that healthcare providers or community members would think they had Covid-19 if they sought care for TB.

Why focus on TB, HIV

According to researchers, while the direct health effects of the Covid-19 pandemic are colossal, and are continuing to grow, the indirect effects of Covid-19 on global health – through the disruption of essential healthcare services – may be even larger and longer lasting.

Tuberculosis and HIV are the two infectious diseases that cause the highest number of deaths globally; in 2018, 1.5 million and 1.1 million people died from TB and HIV-related illnesses, respectively.

A modeling study estimating the impact of severe disruptions to service delivery predicted that HIV and TB deaths could increase by up to 10 per cent and 20 per cent over five years, respectively, in high-burden settings, reverting to levels seen a decade ago.

National programmes for controlling these diseases already face immense challenges and the pandemic has increased these by diverting healthcare professionals and resources to contain Covid-19.

According to researchers, maintaining effective TB control services in Pakistan is critical as this is one of eight countries that account for the majority of the 10 million new TB cases every year.

The newly released Global Tuberculosis Report shows a huge drop (25pc to 30pc) in TB diagnosis owing to disruptions caused by Covid-19.

Urgent action

Prof Mishal S.Khan, the study lead and Associate Professor at the London School of Hygiene and Tropical Medicine, said insights from frontline health professionals should be incorporated into planning of mitigation strategies as Covid-19 numbers had begun to rise.

Prof Khan along with co-investigators Razia Fatima and Dr Afshan Isani, suggested three strategies to minimise health service disruptions.

First, reduce the need for health facility visits by providing medication for longer duration, increasing government community-based services, and using telemedicine.

Second, ensure that affordable transport is available for patients and health providers to reach health facilities, with awareness campaigns to highlight that travel for healthcare is allowed and is safe even during lockdowns.

Third, allocate resources to maintain or expand nutritional and mental health support services as these become more critical when Covid-19 reduces income generation.

“We need to act urgently as progress on TB control is being reversed by Covid-19,” warned Dr Dr Razia Fatima representing the Common Management Unit (HIV/AIDS, TB and Malaria) in Islamabad.

Dr Afshan K. Isani of Stop TB Partnership – a global alliance against TB – underscored the need for informed policy decisions to prevent indirect health impacts of Covid-19 in Pakistan and call for a multi-sectoral action to galvanise TB/HIV response.

Published in Dawn, October 27th, 2020



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