Table 2.

Assumptions of how HIV, tuberculosis, and malaria programmes will be affected by COVID-19 in different response scenarios

	Limitations on activities		Demand on health system		During period of recovery
	Mitigation or well managed suppression	Unmanaged suppression*	High demand	Extremely high demand†
HIV	Care seeking reduced: rate of new ART initiations reduced by 25%, 2% of individuals on ART become virally unsuppressed per month; prevention services partially suspended: no new VMMC, no new PrEP enrolments; reduced social contact: 10% reduction in chance of acquiring new sexual partner	Care seeking reduced: rate of new ART initiations reduced by 50%, 1% of individuals on ART stop per month due to inability to attend appointments; prevention services suspended: no renewals of PrEP prescriptions	Care, medicine, and diagnosis less available at facilities: no new ART initiations, 25% of individuals on ART pre-pandemic have their ART use interrupted, an additional 10% of individuals on ART become virally unsuppressed due to lack of viral load testing; prevention services suspended: no new VMMC or PrEP enrolments; no renewals of PrEP prescriptions	Supply of drugs and commodities interrupted: 50% of individuals on ART pre-pandemic have their ART use interrupted, condom use reduced by 50%	All services and behaviours resume to pre-pandemic levels immediately
Tuberculosis	Care seeking reduced: diagnosis rates decrease by 25% compared with pre-pandemic levels, patient delays before the first presentation to care increased by 25% compared with pre-pandemic levels; displacement of diagnostic resources: diagnosis rate for tuberculosis and drug-resistant tuberculosis decreased by a further 45% due to non-availability of Xpert MTB/Rif diagnostics, yielding overall reduction of 70%; reduced social contact: transmission reduced by 10%	Care seeking reduced: tuberculosis and drug-resistant tuberculosis diagnosis rates decrease by 50%, patient delays before first presentation to care increased by 50% compared with pre-pandemic levels; displacement of diagnostic resources: diagnosis rate for tuberculosis and drug-resistant tuberculosis decreased by a further 20% due to non-availability of Xpert MTB/Rif diagnostics, yielding overall reduction of 70%; prevention services suspended: no new IPT for people with HIV	Care, medicine, and diagnosis less available at facilities: treatment completion rates decrease by 25% for first-line and second-line treatment compared with pre-pandemic levels, patient delays before first presentation to care increased by 50% compared with pre-pandemic levels, drug-resistant tuberculosis diagnosis rates decrease by 50% compared with pre-pandemic levels; prevention services suspended: no new IPT for people with HIV	Supply of drugs interrupted: treatment initiation rates decrease to 50% of pre-pandemic levels; drug-resistant tuberculosis diagnosis rates decrease to 0% (also impacted by diagnosis not being available)	All services and behaviours resume to pre-pandemic levels immediately
Malaria	Care seeking reduced: treatment of clinical cases reduced by 25% compared with pre-pandemic levels; prevention services partially suspended: LLIN mass distribution continues as normal, SMC at 50% of normal coverage	Care seeking reduced: treatment of clinical cases reduced by 50% compared with pre-pandemic levels; prevention services suspended: LLIN mass campaigns halted, SMC halted	Care, medicine, and diagnosis less available at facilities: treatment of clinical cases reduced by 25% compared with pre-pandemic levels; prevention services suspended: LLIN mass campaigns halted, SMC halted	Supply of drugs interrupted: treatment of clinical cases reduced by 50% compared with pre-pandemic levels	Treatment of clinical cases remains at reduced level for 2 months; all other services and behaviours resume to pre-pandemic levels immediately

ART=antiretroviral therapy. VMMC=voluntary medical male circumcision. PrEP=pre-exposure prophylaxis. IPT=isoniazid preventive therapy. LLIN=long-lasting insecticide-treated nets. SMC=seasonal malaria chemoprevention.

^*These changes are assumed to be in addition to those that occur during the mitigation interventions.

^†These changes are assumed to be in addition to those that occur during the period of high demand.