Impact of COVID-19 on tuberculosis and HIV care and treatment services in Addis Ababa, Ethiopia.
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Date
2021-06
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Addis Abeba University
Abstract
Background:Coronavirus disease 2019 (COVID-19) pandemic has infected 173,674,509 people
globally resulting in 3,744,408 deaths as of 09 June 2021.Ethiopia is categorized under COVID19
epidemic phase III (advancing outbreak). There are global concerns and predictions that
COVID-19 would severely affect tuberculosis (TB) and HIV care and treatment services in
resource-constrained countries.
Objective: To assess the real-time impact of COVID-19 on TB and HIV care and treatment
services in Addis Ababa, Ethiopia.
Methods: This was a facility-based, multicentre, cross-sectional study in 10 health centers with
high TB/HIV patients in Addis Ababa, Ethiopia. Participants were patients with TB and/or HIV
who have been attending TB and/or HIV clinical care and treatment in the study sites in the
COVID-19 pandemic period. Data were collected using adapted, interviewer-based
questionnaires to investigate the impact of COVID-19 in their routine care and treatment
services. Data were entered into Epi Info version 7 and exported to SPSS version 26 for analysis.
Variables with a P-value ≤ 0.25 in the bivariate analysis were included in the multivariate
logistic regression. Statistical significance was declared if P-value < 0.05.
Results: The study included a total of 424 informed and consented participants.Study
participants who missed appointments for medication refill were 98 (23.1%).When the effects of
other independent variables on appointments/visits for refill were controlled,the following
characteristics were found to be the most important pridictors of missed appointments (P <
0.05):age ≥55 [AOR=13.74, 95% CI (4.331-436.428)], monthly income 3001-10000
[AOR=0.05, 95% CI (0.003-0.803)], fear of COVID-19 [AOR=59.14, 95% CI (3.804-9195.85)],
transport disruption [AOR=56.91, 95% CI (1.930-16781.4)], reduced income for traveling to
health facility [AOR=12.52, 95% CI (19.115-8194.9)],contacting healthcare providers
quickly[AOR=0.11, 95% CI (0.017-0.742)], soap availability [AOR=0.01, 95% CI (0.0000.845)],
pharmacy accessibility, [AOR=0.01, 95% CI (0.000-0.611)], shortage of some
medications [AOR=10.72, 95% CI (1.033-111.290)], and tremendous shortage of non-medical
support [AOR=15.30, 95% CI (1.075-218.039)].
The participants were well aware of the COVID-19 preventive measures. According to the
participants, the most effective COVID-19 preventive measures were use of facemask (88.4%),
frequent handwashing with soap (81.4%), and staying at home (76.4%). The most costly
COVID-19 preventive measures that cause financial burden to the patients were costs for buying
facemasks [242 (57.1%)], soaps for handwashing [97 (22.9%)], and disinfectants [223 (52.6%)].
Participants responded that the healthcare providers were polite and respectful (99.5%), and
willing to listen and answer their questions (99.5%) and give attention to their individual needs
(98.6%).
Participants who missed follow-up dignositic tests were 97 (22.9%). Variables which were found
to be statisticaly significant included the following: age ≥55 [AOR=0.14, 95% CI (0.021-0.909)],
denied helth services [AOR=0.20, 95% CI (0.054-0.729)], reduced income for traveling to
health facility [AOR=0.06, 95% CI (0.008-0.408)], much harder non medical support
[AOR=0.02, 95% CI (0.001-0.404)].
Participants who missed counseling services were 92 (21.7%). In multivariate logistic regression,
the following were statisticaly significant: age ≥55 [AOR= 0.11,95% CI (0.016-0.733)], denied
health services [AOR= 0.25, 95% CI (0.078-0.787)], fear of COVID-19 [AOR= 0.02, 95% CI
(0.001-0.396)],reduced income [AOR= 0.04, 95% CI (0.005-0.333)], availability of soap [AOR=
22.65, 95%CI (1.302-393.974)], availability of sanitizer [AOR= 3.87, 95% CI (1.069-14.041)],
slightly shortage of medicines [AOR= 0.26, 95% CI (0.081-0.846)].
Conclusion: COVID-19 pandemic impacted the care and treatment services of patients with HIV
and TB negatively. The impact was primarily on their appointments for scheduled medication
refills, clinical and laboratory follow-ups. The impact could be mitigated by providing education
to the public, compensating travel expenses for eligible patients and their healthcare providers,
continuing delivery of TB/HIV care and treatment services.
Description
Keywords
Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), tuberculosis (TB), HIV, clinical care, treatment, Ethiopia