Lessons learned from the COVID-19 pandemic: opportunities and challenges to leverage investments in HIV, tuberculosis and malaria for pandemic preparedness and response

INTRODUCTION: The COVID-19 pandemic strained public health infrastructure in low-income and middle-income countries (LMICs), leading them to leverage resources of existing public health programmes including HIV, tuberculosis (TB) and malaria. This manuscript systematically documents how these programmes were used in response to understand both the barriers and facilitators encountered in the process. METHODS: From March through August 2023, we conducted 72 structured interviews with staff in 13 countries who played central roles in the response. Countries were purposively selected from the pool of countries that receive Global Fund support, are classed as LMIC by the World Bank and speak either French or English. Semistructured, in-depth, individual interviews collected data on experiences, challenges and lessons learnt during COVID-19 response and recommendations for future pandemics. A content and thematic analysis using the framework method was used to identify how resources were leveraged in the response and what facilitated or hindered their engagement. RESULTS: All interviewees reported leveraging of HIV, TB and malaria resources, notably contributing personnel to the response and use of laboratory networks to support COVID-19 testing. Surveillance systems, community networks, infection control and active case finding were also used. Challenges included lack of cross-training among healthcare workers, non-integrated systems and slow funding procedures. CONCLUSIONS: HIV, TB and malaria programmes were important in COVID-19 response. Funding agencies should consider the use of programme-specific infrastructure in 93 emergency response when planning programme-specific financing.