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Competing Health Risks Associated with the COVID-19 Pandemic and Response: A Scoping Review

By Stefan Baral, Amrita Rao, Jean Olivier Twahirwa Rwema, Carrie Lyons, Muge Cevik, Anna E. K├ągesten, Daouda Diouf, Annette H Sohn, Refilwe Phaswana-Mafuya, Adeeba Kamarulzaman, Gregorio Millett, Julia L Marcus, Sharmistha Mishra

Posted 08 Jan 2021
medRxiv DOI: 10.1101/2021.01.07.21249419

BackgroundCOVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats. We conducted a scoping review to characterize the impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. MethodsA scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from January 1st to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection and mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English. ResultsA total of 1604 published papers and 205 preprints met inclusion criteria, including 8.2% (132/1604) of published studies and 10.2% (21/205) of preprints: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (13/166) on sexual and reproductive health, and 12.1% (16/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. DiscussionCOVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. Data reviewed here suggest that effective strengthening of health systems should include investment in public health with adequate funding to ensure continuity of care for emergent and existing public health threats.

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