Critical disruption 1:
Patients and providers getting to HIV and TB health facilities
• Frontline professionals highlighted that transport disruptions, reduced affordability of travel, and lockdowns are impeding access to health facilities for both healthcare providers and patients.
• They noted that these challenges are compounded by patient and health providers’ fears of contracting COVID-19 during travel and at health facilities.
Has it been harder for patients and healthcare providers to access TB and HIV health facilities since COVID-19?*
• Over 40% of respondents reported that it was much harder or impossible for patients to access HIV and TB healthcare facilities.
• Healthcare provider access was also severely impacted - although challenges appeared to be more pronounced for healthcare providers accessing TB health facilities than HIV health facilities.
Barriers to access to TB and HIV health facilities for patients and healthcare workers
Critical disruption 2:
Access to critical non-medical support services for patients
• Impacts on the provision of non-medical support services, such as nutritional supplementation and counselling, were reported to be more severe than on provision of medicines and diagnostic services.
• Less than 20% of frontline professionals reported that critical non-medical support services were operating as they were before COVID-19. Frontline providers stressed that these services are more essential now than ever as COVID-19 has increased economic hardship and food insecurity for many patients.
• They also emphasised the need for mental health services to assist patients in dealing with increased levels of stress, anxiety, and isolation during the COVID-19 pandemic.
Has it been harder to provide medicines, diagnostic services or non-medical support to HIV and TB patients since COVID-19?*
Urgent Actions Policy Makers Can Take to Mitigate COVID-19 Service Disruptions
1) Health and transport departments must proactively collaborate to implement transport schemes (i.e. provision of transport subsidies or private transport) to ensure that healthcare providers and patients can easily access health facilities, placing patients’ rights to privacy at their core.
2) Launch communication campaigns signposting permitted travel to health facilities during lockdowns, transport schemes available and procedures in place to reduce risks of COVID-19 transmission during travel and at health facilities.
3) Uninterrupted drug supply can be achieved by providing medication for longer durations and/or bringing services closer to patients by establishing community medicine collection points or delivering medicines to homes.
4) Implement telemedicine systems for follow-ups and consultations that do not require physical examination.
5) Nutritional and mental health services are even more critical during COVID-19 and should be brought closer to communities or coordinated with health facility visits.
6) Consider and address the impact of service delivery adaptations on stigma. COVID-19 must not be allowed to increase stigmatisation of HIV and TB patients owing to changes in the delivery of health services and transport restrictions.
7) Provide mental health services for those experiencing increased workloads and stress during the pandemic. Consider the use of financial and non-financial incentives, such as improved working conditions, to address motivation.
8) Address physical barriers to health facility access. Transport subsidies or private transport to be availed, to ensure that healthcare providers and patients can access health facilities during the COVID-19 pandemic.
10) Reduce the need for in-person health facility visits. Uninterrupted drug supply can be achieved by providing medication for longer duration, i.e. community medicine collection points or delivering medicines to patients’ homes.
11) Ensure the continuation of non-medical support services and address stigma. Maintain and expand nutritional and mental health support services, COVID-19 must not be allowed to increase stigmatisation of HIV and TB patients owing to changes in the delivery of health services
12) Support healthcare providers. Provide easily available counselling and other mental health services for healthcare providers who are experiencing increased workloads and stress during the pandemic, provide financial and non-financial incentives, such as improved working conditions.