The Impact of the COVID-19 Pandemic on HIV/AIDS and Tuberculosis service delivery in Brazil: Civil Society response

Organisation: Brazilian Tuberculosis Research Network – REDE-TB

Earlier on this year, REDE-TB an IMPAACT4TB grantee rallied other Brazilian civil society partners to understand the impact of the Covid-19 pandemic on HIV/AIDS and TB policies, as well as the diagnostic, treatment and prevention coverage of these diseases in states, capitals, and federal districts of the country.

Problem

The emergence of COVID-19 required extraordinary efforts from the areas of health, social assistance, civil society and academia in all countries to ensure prevention and to offer treatment to people affected by the new coronavirus. Before the pandemic hit, these partners were undertaking political advocacy in partnership with parliamentary commissions on the introduction and scale-up of innovative TB and HIV/AIDS technologies, with a focus on access to newer and short-course preventive treatment for TB (TPT). Faced with the threat of the coronavirus pandemic, alternative strategies were needed.

Intervention

At the end of March 2020, the Ministry of Health, through the Department of Diseases in Chronic Conditions and Sexually Transmitted Infections and the General Coordination for the Surveillance of Chronic Conditions and Respiratory Transmitted Diseases (CGDR-DDCCIST-SVS-MS) published guidelines and circulars for the prevention and treatment of COVID-19 in people living with HIV and AIDS (PLWHA) and TB. Brazilian national movements against AIDS and tuberculosis TB, through community-based research methods, sought to verify the possible impacts of the Covid-19 pandemic on the population undergoing treatment for TB, HIV / AIDS, TB / HIV co-infection, and TB preventive treatment. The focus of this intervention was to verify whether these guidelines were incorporated and implemented in the states, capitals, and Federal District of the country. Lastly, this work sought to understand the impact of the financial and technical sustainability of programs in Brazilian states and capitals.

The signature piece of this effort was the conceptualisation and development of a survey that was conducted by Brazilian civil society. The survey employed a structured electronic questionnaire, with a mixed qualitative-quantitative approach, using Google Docs and SurveyMonkey platforms. Survey data were collected in three stages for three groups of respondents: heads of program, health service users, and health service professionals. Questionnaires were adapted for each group and included both closed and open-ended (descriptive) questions.

Learnings

 Preliminary data covering responses from the program heads points to a major impact of Covid-19 on HIV, AIDS and TB policies. We observed an approximately 40% reduction in access to early HIV diagnosis and loss of laboratory capacity for the diagnosis of TB. In addition, the impacts are noticeable in the areas of social assistance and prevention, including people in need of preventive treatment for TB, as well as in the de-financing of TB and HIV and AIDS programs. These setbacks are associated with prioritizing actions to face Covid-19 and relocating professionals to work in this area. We are currently analyzing data collected from the health professionals and health service users and will share results soon.

Conducting research to monitor public policy is a powerful advocacy strategy. The data collected are a testament to the political impact of civil society. They also enabled a more assertive and purposeful performance in political spaces for the construction of policies to fight TB, such as government commissions, advocacy with the parliamentarian, and other segments of civil society. This effort also speaks to the diversity of Brazilian civil society: this work has benefitted from the expertise of Brazilian AIDS and TB activists, with the support of the National Articulation Against AIDS (ANAIDS), the Brazilian Social Articulation for Confronting Tuberculosis (ART TB BRASIL), the Community Committee for Monitoring Tuberculosis Research in Brazil (CCAP TB Brasil), and the Civil Society Segment of the Brazilian Partnership against Tuberculosis, and the Civil Society Task Force for WHO (WHO-CSTF).

Written by Carla Almeida & Jose Carlo Veloso

 Carla and Veloso, two civil society leaders in Brazil supported by the IMPAACT4TB project, write about how civil society acted quickly to protect TB and HIV programs against the worst impacts of COVID-19.