Chronic diseases are the leading cause of death and disability worldwide and account for 80% of deaths in people with chronic diseases [1]; moreover, this threat is growing, especially in low-and middle-income countries (LMICs) instead of achieving the goal of reducing death by 2% through comprehensive and integrated actions at a country-led level [2]. The abrupt emergence of the virus known as COVID-19 has disrupted the access to and utilization of priority programs and services worldwide due to the implementation of lockdown regulations [3]. Even though the chronic disease is one of the priority programs aimed to reduce the burden of disease, the current management measures for COVID-19 prevention are not in compliance with the World Health Organization’s (WHO’s) approach for the prevention, control, and management of chronic diseases [3]. In South Africa, the COVID-19 pandemic control was highly politicized; this has exerted even more pressure on the country’s healthcare system which is already overwhelmed by the burden of diseases, which include the human immunodeficiency virus (HIV, acquired immune deficiency syndrome (AIDS), tuberculosis (TB), diabetes mellitus (DB), cardiovascular disease, cancer and hypertension (HPT) [4]. HIV and non-communicable diseases (NCDs) are more prevalent in LIM countries, mainly in sub-Saharan Africa [5]. According to [6], out of 56 million deaths reported globally, 38 million were associated with NCDs, which raised from 59% in 2002 to 69% in 2010. The number of people living with HIV (PLHIV) increased from 31 million in 2010 to 38 million in 2018, even though there has been a significant improvement since 2017, 50% of new HIV infections have occurred among important populations [5, 7]. According to [6], NCDs are usually neglected during medical emergencies since the focus would be on infectious disease outbreaks and such NCDs are not taken into consideration as part of emergency response [5, 7]. HIV and NCDs are now regarded as major chronic diseases of public concern, especially in lower-middle-income (LMI) countries [8]. The sudden shift in healthcare priorities was observed when countries were trying to curb the spread of COVID-19. Such disruptions to health priorities affect people with chronic diseases [9]. In addition, traveling was banned and changes in the operation of transport services affected the access [10, 11]. Fear and feelings of uncertainty among healthcare providers (HCPs) and the community about the disease were observed as there was not enough information regarding the surveillance, prevention, control, and management of COVID-19. Furthermore, compliance and retention to care and treatment were disrupted and identified through a high number of missed appointments. Consequently, this has prompted the researchers to conduct a detailed study investigating the impact of the COVID-19 pandemic on the management of chronic diseases in South Africa and the African healthcare community, aimed at mitigating the potential harm of the pandemic’s public health measures to NCD control.

The goal of the study was to review the available literature to obtain a broader perspective on the impact of the COVID-19 pandemic in the management of chronic diseases, which include HIV and NCDs to propose strategies to policymakers, patients and HCPs in order to improve health outcomes and mitigate the potential harm of public health measures to NCDs control. The study was guided by the following questions: What is the impact of the COVID-19 pandemic on the management of chronic diseases in South Africa?

The review was conducted following the preferred reporting items for systematic review and meta-analysis (PRISMA) and a quality assessment and review instrument to synthesize qualitative and quantitative studies to identify key findings and answer the review question [13], (Fig. 1 and Table 1).

Fig. (1). Systematic review flow chart adopted from preferred reporting items for systematic review (PRISMA).

A total of 17 studies were reviewed and analyzed. The majority of these included South African (52.9%) and other African countries' studies conducted in collaboration with western countries. Most studies were researchers’ commentaries, notes, lessons learned, and perspectives during the COVID-19 pandemic (52,9%) while a few empirical studies were conducted on patients (64,7%) and healthcare providers (17,6%); this may impose a risk of bias and quality as it is based on researchers’ personal opinions or perspectives. The types of chronic diseases included hypertension, diabetes mellitus, PLHIV on ART, cardiovascular disease, and stroke. Studies were conducted using quantitative and qualitative designs. The majority of studies were published in 2020 and 2021, and participants were mainly people with chronic diseases and healthcare providers. Three themes were identified, which are listed as follows: the impact of the COVID-19 pandemic on healthcare services; the impact of the COVID-19 pandemic on the management of people with chronic diseases; and the digitalization of healthcare services as illustrated in Table 2 below:

The WHO and the national Department of Health in South Africa and other African countries should develop an integrated NCD and infectious disease chronic care model and protocols for screening, diagnostic, prevention, and treatment using a community-based approach during medical emergencies to reduce mortality and comorbidity in the African region. This would also address inequalities in accessing health services, mitigate future effects, and enhance preparedness for future pandemics.

healthcare institutions should initiate and implement innovative ways of central dispensing, pre-packaging, and home delivery of medication during medical emergencies to reduce facility congestion, long waiting times, and improve access to treatment using local pharmacies, volunteers, non-governmental and community-based organizations, and community health workers via Uber, courier, bicycle, vehicles and electric scooters.

The use of telemedicine or digital technology during medical emergencies should be enhanced and adopted as new, normal interventions with support to cater to people with chronic diseases as an initiative to prevent comorbidities.

Mental health services should be optimized to provide support, counseling, and assist patients and HCPs to develop positive coping skills or mechanisms; and ensure the continuity of care, including social services to deal with gender-based violence and loss of jobs.

The sudden emergence of COVID-19 with little or non-preparedness of the healthcare system has harmed the management of NCDs. Chronic diseases are high in LMICs, which include South Africa and Africa as a whole, and contribute to 60% of deaths annually [1].

The literature reveals that access to chronic healthcare services has been severely interrupted by the COVID-19 pandemic and lockdown regulations intended to prevent and control the spread of infection. This has led to changes in facility triage criteria to receive specialized care, reorganization of facility streams, frequent and abrupt closure of health facilities, transport services and movement, disruption of routine chronic disease management, disturbance of community-based services, and long waiting times. The following studies [3, 18, 26-28], argue that there is clinical bias and discrimination when conducting triage in persons with a disability. Other studies claim that patients who needed healthcare services were denied access to specialty care such as rehabilitation and COVID-19-related care, intensive care, and ventilators. This is relevant to what the literature revealed that services for people with chronic diseases such as stroke were interrupted and not given priority [29].

This is against human rights and the United Nations Convention on the Rights of People Living with Disabilities and worsening health inequalities and such barriers should be dealt with decisively. The prevention and treatment services of NCDs have been severely disrupted by the pandemic, especially in LMICs, and are of high concern as people living with NCDs are at higher risk of severe COVID-19-related illness and death [17, 30-33]. In addition, reduced access to healthcare services and the disruption of chronic disease management during the COVID-19 pandemic increased the burden of NCDs on the healthcare system, community, and economy of the country, especially in LMICs. A study conducted in Nigeria by [34], confirms the need to reinforce and scale up interventions proactively rather than reactively. Therefore, the prevention and management of chronic diseases may reduce health expenditure in many African countries [35].

The South African healthcare system is already experiencing the challenges of poor infrastructure, shortage of staff, and medical resources, which were made worse by the current pandemic and were confirmed by studies conducted by [2, 3, 27, 28]. The reduced frequency of clinical consultation, changes in eligibility criteria for stable patients on treatment, and self-care management by people with chronic diseases due to COVID-19 have affected the investment and progress made so far concerning the reduction of the burden of disease [3]. Studies conducted by [18, 19] indicate that a reduction in clinical visits was observed during the stringent lockdown levels 5 to 4, while [11, 13] maintain that the eligibility criteria for a repeat prescription of chronic patients stable and adherent to treatment was expanded to children, adolescents, and pregnant and breast-feeding women with chronic disease and living with HIV and ART [16]. state that COVID-19 has had a negative impact on the diet, lifestyle, exercise, income, access to health care, anxiety, and stress levels of people with chronic diseases. Therefore, the psychological or mental health impact of the COVID-19 pandemic on both people with chronic diseases and their related healthcare providers has affected the safety and quality of care. This was supported by a study conducted in China by [7, 36-39], on the psychological impact of the COVID-19 pandemic, which revealed anxiety, stress, depression, insomnia, and somatic illness among healthcare providers and patients.

The transition to digital care without prior knowledge, support, and poor access to the Internet or ICT infrastructure limits self-care management and information and needs serious attention to achieve the intended outcomes of good adherence to and compliance with treatment [8, 10], found that COVID-19 brought changes in routine care to virtual communication and people with chronic diseases as they have to adapt and adjust to digital technology and telemedicine that is not available in LMICs.

The purpose of the study was to analyze full-text studies to obtain a broader view of the impact of the COVID-19 pandemic on the management of chronic diseases. The literature revealed that COVID-19 significantly harmed NCDs hence affecting the healthcare system, people with chronic diseases, and healthcare providers. The study was limited to an African and South African context and further studies can be conducted to assess its global impact. COVID-19 and chronic diseases are both international public health concerns and call for equal attention.