Interventions to maintain HIV/AIDS, TB and malaria service delivery during public health emergencies in low- and middle-income countries: a systematic review

Résumé fourni par la source

Health emergencies disrupt delivery and access to essential services like HIV/AIDS, TB and Malaria, particularly in low- and middle-income countries that have high disease burdens plus frequent emergencies. We aimed to describe the interventions that have been reported in the literature to maintain HIV/AIDS, TB and malaria services during health emergencies. We conducted a systematic review of studies in Medline, Web of Science, Embase, Cochrane and Global Index Medicus. Interventions for HIV (prevention, testing, linkage to and retention in care, ART adherence, viral suppression), TB (screening, testing, linkage to treatment, retention, post-treatment survival and cure) or malaria and implemented during public health emergencies of international concern. The search yielded 8134 records, of which 36 were included in the review. Interventions included modifying existing policies, introducing new policies, and maintaining facility-based services. Modifying existing policies involved leveraging existing platforms for service delivery (e.g. using telehealth to conduct pre-exposure prophylaxis consultation), modifying existing logistics operations systems (e.g. private pharmacies to distribute ART), combining operational workflows (e.g. integrating TB screening and diagnosis into response) and scaling up self-care (e.g. HIV self-testing). New interventions included population-based interventions (e.g. mass administration of antimalarials) and policy-level interventions (e.g. removing user fees). Two studies (5.6%) evaluated health-care outcomes such as viral suppression, while 3 (8.3%) assessed both process and outcome measures. In public health emergencies, response operations should be conducted while minimising the disruption to health facility-based service provision. Secondly, community structures can be leveraged for service continuity to address the geographical barriers to health access that are exacerbated during public health emergencies. Relatedly, self-care and self-management were critical for bridging difficulties in health access. Information Technology was also important for automating services and minimising the need for physical interactions. Lastly, monitoring impacts should include process and outcome measures.

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