Maintaining routine HIV and tuberculosis testing services in sub-Saharan African countries in the context of COVID-19: Lessons learnt and opportunities for improvement

Since being declared a public health emergency of international concern on 30 January 2020, the coronavirus disease 2019 (COVID-19) has spread internationally, reaching the stage of a global pandemic. 1 African countries quickly put in place social and public health measures to limit the spread of the disease, with some of the most ‘visible’ measures being lockdowns, physical distancing and the overall surge of healthcare services to support the COVID-19 response. The Director-General of the World Health Organization, calling for increased testing, recommended ‘test, test, test’ as a critical step to contain the spread of the disease. 2 When the first African case was reported in Egypt in February 2020, only two centres of excellence laboratories on the continent were capable of conducting severe acute respiratory syndrome coronavirus 2 polymerase chain reaction testing, the gold standard assay recommended by the World Health Organization. [...]the Joint United Nations Programme on HIV/AIDS estimates that there could be hundreds of thousands of extra deaths from HIV if routine services, including HIV screening, viral load and early infant diagnosis, are disrupted. 6 Eighty-five percent of national-level respondents from 61 countries participating in a World Health Organization, United Nations Children’s Fund and Global AIDS Vaccine Initiative poll reported lower vaccination proportions in May 2020 compared to the level in January 2020 – February 2020. Two separate analyses indicated that most HIV and tuberculosis instruments are often operated below their full capacity, 14 , 15 indicating that available instruments in most countries may be sufficient to support both COVID-19 and HIV and/or tuberculosis testing. [...]under the impulse of strong HIV and tuberculosis disease control programmes funded by the United States President’s Emergency Plan For AIDS Relief and the Global Fund, the equipment is used almost exclusively for one disease area due to vertical programming, despite the instruments’ multiplexing capability and the recommendation to ‘integrate’ testing. 16 Additionally, many of the countries who either repurposed HIV and/or tuberculosis equipment for COVID-19 testing or refocused testing still experience challenges in long turn-around times for results, quality assurance and procurement issues, among others, indicating systemic weaknesses that need attention.