JMIR Publications

ABSTRACT

Background:

Although existing disease preparedness and response frameworks provide guidance about strengthening emergency response capacity, little attention is paid to the importance of maintaining service delivery during emergency response. During the 2014 Ebola Outbreak of West Africa, 11,325 deaths were due to the Ebola Virus and yet the disruption in access to care caused more than 10,000 additional preventable deaths due to measles, HIV/AIDS, TB and malaria. The COVID-19 pandemic also significantly reduced overall health care utilization. Low and middle-income countries account for the largest disease burden due to HIV, TB and Malaria and yet previous responses to public health emergencies of international concern showed that HIV, TB and Malaria service delivery can be significantly disrupted. To date, there has not been a systematic synthesis of the interventions implemented to maintain the demand for and delivery of HIV, TB and malaria services during emergencies. Recent reviews have mainly focused on the challenges or the interventions for delivery of maternal and child health services during emergencies.

Objective:

We aim to conduct a synthesis of the interventions implemented to maintain HIV/AIDS, TB and Malaria services during responses to public health emergencies of international concern in low- and middle-income countries.

Methods:

The systematic review was registered in the international register for prospective systematic reviews (PROSPERO Registration #CRD42023408967). This qualitative review will include activities undertaken to improve human health either through preventing the occurrence of HIV, TB or malaria, reducing the severity of HIV, TB or malaria among patients or promoting the restoration of functioning lost as a result of suffering from HIV, TB or malaria during public health emergencies. These will include policy level interventions (e.g. development of guidelines), health facility level interventions (e.g. service rescheduling) and community level interventions (e.g. community drug distribution). Service delivery will be in terms of improving access (physical, economic ability to use services), availability (physical presence of services), utilization (quantity of services used), and coverage (proportion of people who access a needed service). We will report on any interventions to maintain services along the cascade of care for HIV, TB or malaria. Peer reviewed article databases including Medline, Web of Science, Embase, Cochrane and Global Index Medicus will be searched. Reference lists from Global reports on HIV/AIDS, TB or Malaria will also be searched. We will use the GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative Research) approach to report on the quality of evidence in each paper. The information from the articles will be synthesized at disease/ condition level (HIV/AIDS, TB, Malaria or a combination of these), at implementation level (policy, health facility, community) and outcomes (improving access, availability, utilization or coverage of services). We will use the PRISMA checklist to report findings and discuss the implications for strengthening both preparedness and response, as well as strengthening health systems in low- and middle-income countries.

Results:

The initial search for published literature yielded 8,119 articles from online databases. This search was conducted between January and March 2023. At the time of publication, synthesis and interpretation of results were being concluded. Final results will be published in 2024.

Conclusions:

Findings will inform the development of national and global guidance to minimize disruption of services for HIV/AIDS, TB and Malaria during public health emergencies. Clinical Trial: Not Applicable