COVID-19 Lockdowns: Impact on Facility-Based HIV Testing and the Case for the Scaling Up of Home-Based Testing Services
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COVID‑19 Lockdowns: Impact on Facility‑Based HIV Testing and the Case for the Scaling Up of Home‑Based Testing Services in Sub‑Saharan Africa Malizgani Mhango1 · Itai Chitungo2 · Tafadzwa Dzinamarira3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
The Covid‑19 Pandemic and Lockdowns In December 2019, China reported the emergence of a pneumonia of unknown cause in Wuhan [1]. By 7 January 2020, the etiology of the pneumonia was attributed to a virus of the coronavirus family, and later on the disease was named coronavirus disease (COVID-19) on 11 February 2020 by the WHO [2, 3]. The symptoms of COVID-19 appear after an average incubation period of 5.2 days [1]. The median period from the onset of the disease to death is 14 days (range 6 to 41) [3]. Transmission of the virus is human to human through direct contact, or air droplets from infected persons spread by coughing or sneezing. The infection droplets can also contaminate surfaces, and the virus can remain infectious for several days in the environment, providing a reservoir for the infection [4]. The majority of infections go into remission without intervention, while approximately 15% will require hospitalization, with approximately 5% of these requiring intensive care [3, 4]. Unmitigated spread of COVID-19 creates pressure on health systems, and diverts resources that could have otherwise been better utilized for other health conditions. Sub-Saharan Africa health systems * Tafadzwa Dzinamarira [email protected] Malizgani Mhango [email protected] Itai Chitungo [email protected] 1
School of Public Health, University of Western Cape, Cape Town 7535, South Africa
2
Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
3
Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
are already strained and are characterized by poor health outcomes with high mortality rates linked to the triple burden of disease (HIV, tuberculosis, and non-communicable diseases) and out of pocket healthcare. In response to the epidemic China imposed restriction such as quarantine (lockdown) of the whole city of Wuhan. This model proved efficacious, resulting in some Sub-Saharan Africa countries implementing the same. The lockdown measures are in no way aimed at ending the pandemic but seek to protect the health systems of countries from being overwhelmed by flood of infected and sick patients needing medical care. However, the restrictions come with unintended consequences, such as widening inequalities, mental health problems, and exacerbating poor medical outcomes that are not COVID-19-related. Of particular interest to this paper, The Joint United Nations Programme on HIV and AIDS (UNAIDS) and the World Health Organization (WHO) have announced that the number of AIDS-related deaths in Sub-Saharan Africa could double if access to healthcare for people living with HIV (PLW
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