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Vantage Health Technologies and the Institute for Human Virology, Nigeria (IHVN) join forces to keep patients on treatment.

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    Public-private data project a COVID game-changer in West and East Africa

    The USAID-funded Regional Action Through Data (RAD) programme launches game-changing daily COVID dashboards in West and East Africa and a ground-breaking childhood cross-border immunisation programme that could be a model for future COVID passport initiatives across these regions

    A cross-border data collaboration project involving 23 African countries above the Equator is proving to be a game-changer for the tracking and management of COVID-19 and other epidemic-prone diseases in the region – and is launching the first ever daily public COVID dashboard for countries in the Horn of Africa next month.

    The USAID-funded Regional Action Through Data (RAD) programme is tackling COVID-19 in West and East Africa through two initiatives, respectively involving the sharing of real-time regional disease data online and tech-enabled cross-border immunisations. These initiatives are enabling governments to better collaborate to protect their roving pastoral populations from epidemics and to overcome the data issues of the Ebola era.

    Game-changing COVID-19 dashboards enable daily regional epidemic tracking  

    Ebola became a deadly disaster six years ago due to inadequate and irregular, at best weekly, information sharing among affected countries. But this scenario will soon be a thing of the past, with the Intergovernmental Authority on Development (IGAD) trade bloc in Central and East Africa getting its own daily online disease outbreak dashboard before the end of June 2021. Currently the tracker shows monthly graphs, but soon new daily regional information will be available as well. The dashboard allows its eight member countries in the Horn of Africa, Nile Valley and African Great Lakes regions to share epidemic data on a daily basis for the first time.

    The IGAD dashboard follows on RAD’s recently unveiled “disease outbreak dashboard” for the West African Health Organization (WAHO). The WAHO COVID-19 Dashboard is freely available on the WAHO website and offers information, maps and tables to reflect how COVID is manifesting daily in the region. It will soon also track other epidemic-prone diseases. WAHO is the health arm of the Economic Community of West African States (ECOWAS) and serves 15 countries including Ghana, Nigeria and Mali.

    The RAD programme was launched in 2016 in response to the Ebola pandemic to identify and co-create actionable solutions for pressing African health needs and pivoted to deal with COVID last year. It is a USAID collaboration with both WAHO and IGAD, with implementation led by BroadReach Health Development.

    Implementation partner BroadReach’s health-tech experts are providing prime oversight and support, in collaboration with Duke University and Jembi Health Systems NPC, who provide policy and technical support.

    These publicly accessible online dashboards are an absolute game-changer for all partnering countries, especially in jointly managing the health of migratory populations in real-time, says Geoffrey Arunga, Regional Analyst for the RAD project in BroadReach, who manages the data functionality of the dashboards.

    WAHO’s online COVID map reveals daily hotspots across West Africa 

    Dr. Andrew Kitua, BroadReach’s Regional Programme Director of RAD, who manages the implementation of the programme, says: “The emergence of COVID-19 has again highlighted how diseases can emerge from anywhere and spread rapidly across continents in this globalised era, but now through our RAD work we are able to use real-time data sharing to empower health authorities to respond immediately to outbreaks – outbreaks that have no respect for borders.”

    This kind of data-sharing could future-proof Africa against the next pandemic, by driving the supply of data, sharing and policy, and managing actual demand for health products and production, said Kitua. It also motivates health workers who can now see the fruits of their labour and “helps defeat COVID denialism” in political leaders who are now confronted with robust regional data.

    Ground-breaking cross-border childhood immunisation programme 

    IGAD which comprises Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda, has also launched a ground-breaking cross-border childhood immunisation programme, called the “Journey Solution”, which uses credit card technology to ensure that nomadic populations stay on track with essential childhood vaccinations across borders.

    The Journey Solution gives parents custodianship of their children’s electronic health data through electronic immunisation cards that health workers can swipe to see the child’s immunisation history, which is also stored in the Cloud.

    “This card technology helps us run ahead of diseases. It can follow in the footsteps of the yellow cards issued for citizens of countries with a high prevalence of Yellow Fever, and can be the forerunner to a type of COVID passport for the region that will become necessary once immunisations become the norm and require tracking,” says Arunga.

    The RAD project wraps up in September 2021, but was designed to enable governments, regions and their health partners to sustainably continue tracking and managing epidemic-prone diseases into the future.

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    JIAS study: Same‐day antiretroviral therapy is associated with increased loss to follow‐up in South African public health facilities: a prospective cohort study of patients diagnosed with HIV

    Abstract

    Introduction

    South Africa introduced Universal Test and Treat in 2016 including antiretroviral therapy (ART) initiation on the same‐day as HIV diagnosis. Our study sought to evaluate the impact of same‐day ART initiation on loss to follow‐up (LTFU) and mortality comparing with patients who initiated ART after their HIV diagnosis.

    Methods

    We conducted a file review of patients with a HIV diagnosis and ART start date on file between September 2016 and May 2018 in six high HIV burden districts. Our primary outcome was LTFU (>90 days from the last clinical visit or drug pick‐up until database closure 31 July 2018). The secondary outcome was mortality after ART initiation. Time to outcome was assessed comparing same‐day vs. one to seven, eight to twenty‐one and ≥ twenty‐two days to ART initiation using Kaplan‐Meier estimators stratified by sex. We investigated predictors using univariate and multivariable Cox proportional hazards models, adjusting for a priori characteristics.

    Results

    Overall, 92,609 ART patients contributed 43,922 person‐years from ART initiation, with a median follow‐up time of 246 days (IQR = 112 to 455). Of these patients, 33,399 (36%) initiated ART on the same‐day as their HIV diagnosis date and had a median follow‐up time of 174 days (IQR = 85 to 349). Same‐day patients were predominantly non‐pregnant females (56%) and aged 25 to 34 years (40%). Same‐day ART initiation increased from 2.8% in September 2016 to 7.1% in April 2018. In same‐day patients, 33% (n = 11,114) were classified as LTFU with a median time of 55 days (IQR = 1 to 185), compared to 371 mean days (IQR = 161 to 560) in patients who initiated ≥22 days after diagnosis. A similar proportion of LTFU was observed for patients who initiated later: 31% 1 to 21 day and 33% ≥22 day. Same‐day ART patients had an increased risk of LTFU vs. ≥1 day (adjusted hazard ratio (aHR) = 1.28, 95% CI = 1.24 to 1.33) adjusting for covariates. Although all‐cause mortality was slightly lower in same‐day patients (0.9%) vs. >1 day (1.4%; aHR = 0.87, 95% CI = 0.72 to 1.05) adjusting for covariates. Men had highest risk of mortality and LTFU.

    Conclusions

    Same‐day ART increased the risk of LTFU, but same‐day patients experienced slightly lower mortality. Same‐day patients may require additional counselling and interventions to improve retention. Additional research is needed on targeted interventions, including differentiated care, to reduce LTFU in patients initiating ART same‐day.

    Read the full study on JIAS here. 

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