COVID-19 weighs on South Africa’s HIV and TB burden
Tanya Nielson – #IASONEVOICE

The COVID-19 pandemic is causing much uncertainty around the world, including for people living with and affected by HIV. South Africa has the largest HIV treatment programme in the world: some 7.7 million people live with HIV and more than 5 million access treatment. In addition, around 60% of people living with HIV in South Africa are co-infected with tuberculosis. TB is the leading cause of death in South Africa, with an estimated 320,000 new infections and 78,000 deaths in 2018. To date, 7,220 people are confirmed with COVID-19, adding a heavy burden to this scenario. Tanya Neilson discusses managing HIV and TB care in South Africa in the COVID-19 era...

I qualified as a pharmacist and have been involved in conducting HIV and TB clinical trials for more than 14 years. I am currently the Managing Director of the Clinical Research Division at The Aurum Institute, one of the largest non-governmental organizations in South Africa dedicated to researching, supporting and implementing innovative, integrated and high-impact programmes in response to HIV and TB.

In a country where the healthcare system is already overburdened and under-resourced, the addition of another communicable disease, such as COVID-19, will be extremely challenging to manage.

A lot of thought and planning is going into maintaining access to sustained HIV and TB care during an impending health crisis. This includes planning to decongest clinics, focusing on hygiene interventions, and making sure that antiretrovirals and TB drugs are available for extended periods to limit the required clinic visits. Clear messaging is being developed to emphasize the importance of medication for all people living with HIV and TB. Flu vaccines are offered to more vulnerable patients; however, ensuring a sufficient stable supply of vaccines has been challenging.

Exploring new approaches

The Aurum Institute is involved in a number of HIV and TB prevention and vaccine trials, but the pandemic has significantly slowed them down. We are conducting only critical visits (telephonically as far as possible). We need to find new and innovative ways of collecting information in a way that does not increase the risk to participants or staff. New systems must be implemented to screen participants and staff for COVID-19 and to ensure that sufficient protection is provided. This could also be an opportunity for new trials looking at COVID-19 in populations affected by HIV and TB.

I do not think that it is possible for any country’s health sector to be ready to fully respond to COVID-19 while ensuring continuity of care – not even high-income countries with much more resources and a much lower burden of HIV and TB than South Africa. South Africa had a bit of extra time to learn about COVID-19 from other countries and it acted faster in implementing a nationwide complete lockdown which was initiated on 27 March 2020, initially for 21 days, then extended to 35 days. Currently, we have a five-stage, evidence-informed lockdown strategy. It is too soon to know whether the lockdown is enough to flatten the curve, but we are hoping that it will have a significant impact on reducing the spread of SARS-CoV-2.

We also hope that the resources and health networks built to respond to the HIV and TB epidemics will help battle the new pandemic as the response requires the same skills to find, treat and prevent further infections. The Aurum Institute, as well as other Department of Health partners, has extensive experience in tracing treatment defaulters, which would make it ideal for these partners to be placed on national duty to conduct contact and home tracing for COVID-19. We are seeing a united response from the private and public sectors, global collaborations and global efforts to fight this pandemic.

One strategy implemented by The Aurum Institute, with the Department of Health and the company, Technovera, has been the introduction of Pelebox for medication collection. It generates an SMS message to inform clients that their parcel is ready for collection. This filters to a Department of Health service provider, which packs and delivers chronic medication.

This collection strategy was implemented before the COVID-19 pandemic, but is ideal for ensuring continued client care with minimal waiting times. The technology reduces client waiting time from three hours to 22 seconds, on average. The Pelebox is also easy to disinfect as the ATM screen is impermeable. The department has indicated that it should be used as preferred pick-up points during this period.

A personal impact

For me and the other employees at The Aurum Institute, the impact of the disease was experienced very early when we lost Professor Gita Ramjee, our Chief Scientific Officer, to COVID-19. Gita was one of the first people in South Africa to die due to COVID-19. She was an HIV prevention stalwart, a world-renowned researcher and a fighter for equality and women’s rights. This was a heavy blow to us, but has inspired us to continue to do what we can to make a difference in our communities and in South Africa.

The impact of the COVID-19 pandemic on my personal life has required a lot of changes in plans. As a social creature, this time has reminded me of the importance of family and friends, and how we take small things for granted all the time. I will have huge appreciation for small things that made me happy if we ever return to something vaguely similar to what used to be “normal”.

My professional life involves extensive travel to our clinical trial sites, meetings and conferences. The pandemic has forced us to find different ways of conducting remote meetings, attending virtual conferences and limiting travel to the absolute minimum. We are lucky to live in an age where technology brings us closer, but it will never replace our need to network and connect in person.