New project to investigate pandemic’s impact on HIV and TB care in Indonesia

News | Published on 19 Oct 2020

1.4 million has been awarded to a collaboration between researchers in Indonesia, the United Kingdom and Australia, co-led by the Kirby Institute’s Professor Virginia Wiseman.

Whilst medical and healthcare workforce resources have necessarily been deployed to combat the COVID-19 pandemic, other health challenges remain. In Indonesia, the fourth most populous country in the world, tuberculosis (TB) and HIV remain significant health threats while the nation works to manage the highest number of COVID-19 cases in South-East Asia.

Indonesia has the third highest TB burden globally, and is one of the only countries whose HIV transmission rates are increasing. While Indonesia has recently strengthened efforts to control these diseases, the diversion of resources to the COVID-19 pandemic, combined with social distancing policies, is creating new vulnerabilities and exacerbating existing ones for people who rely on TB and HIV services. Modelling suggests that if disruption to TB and HIV health services globally last for over six months, there could be a staggering 1.4 million extra deaths from TB-related illness and over 500,000 deaths from HIV. If correct, these predictions correspond to death rates for HIV and TB last seen globally more than a decade ago.

To mitigate this, the UK’s National Institute for Health Research and UK Research Innovation have awarded £780,000 (AU$1,423,200) through their Global Effort on COVID-19 (GECO) Health Research funding scheme to an innovative project that will evaluate the impact of the COVID-19 pandemic on HIV and TB care in Indonesia.

The project, called ‘The DOMINO Study: Measuring and mitigating the indirect effects of COVID-19 on TB and HIV care in Indonesia’, is led by Universitas Gadjah Mada, Universitas Indonesia, Universitas Sebelas Maret in Indonesia, the London School of Hygiene and Tropical Medicine and the Kirby Institute at UNSW Sydney.

“While TB and HIV differ substantially in terms of populations affected, transmission and prevention, both require highly organised medical interventions to achieve control,” says Professor Virginia Wiseman, who is principal investigator on the study. She holds joint appointments at the Kirby Institute and the London School of Hygiene and Tropical Medicine. “Despite Indonesia’s efforts to address gaps in TB and HIV care, the diversion of resources to COVID-19 and social distancing policies are impacting on access to care, which is a major concern.”

Co-principal investigator Professor Ari Probandari says that the project will provide invaluable data on the health and economic impact on TB and HIV patients to Indonesia’s Ministry of Health, to help inform appropriate policy and practice, as well as the allocation of resources, to safeguard Indonesia’s health system. “This project will provide directions to strengthen the tuberculosis and HIV program's resilience in Indonesia that has been challenged by the COVID-19 pandemic,” says Professor Probandari.

It will also address a major knowledge gap around the impact of COVID-19 on out-of-pocket healthcare spending by TB- and HIV-affected households; costs which could be debilitating.

“The COVID-19 pandemic is impacting on health systems in so many ways, and this has a flow-on effect to individuals and households, especially in low- and middle-income countries like Indonesia,” says Professor Wiseman. “This project will provide the data to ensure Indonesia continues to make strides in TB and HIV care whilst handling the ongoing pandemic. A robust health system is critical to saving lives.”

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Courtesy of the Center of Tropical Medicine, Universitas Gadjah Mada