Suchergebnisse

BackgroundZimbabwe has been severely affected by the HIV/AIDS and tuberculosis epidemics, with an estimated 80% of tuberculosis patients being HIV infected. We set out to use annual population‐mortality records from the cities of Harare and Bulawayo to describe trends and possible causes of mortality from 1979 to 2008. The specific objectives were to document overall, sex and age‐specific mortality, proportion of deaths attributed to AIDS and tuberculosis, and changes in death rates since the start of antiretroviral therapy in 2004.MethodsThis retrospective descriptive study used existing mortality records of the Health Services departments in Harare and Bulawayo. Data points included: estimated yearly total population; groupings by sex and age; deaths (total and by sex and age groups for each year of the study period); and most frequently reported causes of death (for age groups <15 years, 15‐44 years and ≥45 years). Data on deaths were aggregated by year, and crude, sex‐ and age‐specific death rates were calculated per 1000 population. Tuberculosis and HIV‐related disease‐specific death rates and proportion of deaths attributed to these conditions were computed.ResultsIn both cities, crude death rates were lowest in the late 1980s, increased three‐ to five‐fold by the early 2000s, and began a slow and, in the case of Bulawayo, intermittent decline from 2004. Sex‐specific death rates followed a similar trend, being higher in males than in females. The death rates in the age groups <5 years, 15‐44 years and ≥45 years showed significant increases, with a gradual levelling off and decline from 2002 onwards; death rates in those aged 5‐14 years were relatively unaffected. Tuberculosis and HIV caused 70% of deaths in the age group of 15‐44 years from the early 1990s.ConclusionsThis study used routinely collected population‐mortality data that are rare in resource‐limited settings, and it described, for the first time in Zimbabwe, the effects of the HIV/AIDS epidemic and the introduction of antiretroviral therapy on death rates in two large cities. After a substantial rise in crude mortality rates, there has been a decline associated with the introduction of ART. Such routine population data must continue to be collected, collated and analyzed.

AbstractIntroductionUntil COVID‐19, tuberculosis (TB) was the leading infectious disease killer globally, disproportionally affecting people with HIV. The COVID‐19 pandemic is threatening the gains made in the fight against both diseases.DiscussionAlthough crucial guidance has been released on how to maintain TB and HIV services during the pandemic, it is acknowledged that what was considered normal service pre‐pandemic needs to improve to ensure that we rebuild person‐centred, inclusive and quality healthcare services. The threat that the pandemic may reverse gains in the response to TB and HIV may be turned into an opportunity by pivoting to using proven differentiated service delivery approaches and innovative technologies that can be used to maintain care during the pandemic and accelerate improved service delivery in the long term. Models of care should be convenient, supportive and sufficiently differentiated to avoid burdensome clinic visits for medication pick‐ups or directly observed treatments. Additionally, the pandemic has highlighted the chronic and short‐sighted lack of investment in health systems and the need to prioritize research and development to close the gaps in TB diagnosis, treatment and prevention, especially for children and people with HIV. Most importantly, TB‐affected communities and civil society must be supported to lead the planning, implementation and monitoring of TB and HIV services, especially in the time of COVID‐19 where services have been disrupted, and to report on legal, policy and gender‐related barriers to access experienced by affected people. This will help to ensure that TB services are held accountable by affected communities for delivering equitable access to quality, affordable and non‐discriminatory services during and beyond the pandemic.ConclusionsSuccessfully reaching the related targets of ending TB and AIDS as public health threats by 2030 requires rebuilding of stronger, more inclusive health systems by advancing equitable access to quality TB services, including for people with HIV, both during and after the COVID‐19 pandemic. Moreover, services must be rights‐based, community‐led and community‐based, to ensure that no one is left behind.