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1.
Pan Afr Med J ; 39: 93, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34466195

RESUMO

Widespread vaccination provides a means for countries to lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. However, to date, Africa has secured enough COVID-19 vaccine doses for less than 5% of its population. With widespread vaccination not on the horizon for Africa, there is a strong emphasis on non-pharmaceutical interventions which include movement restrictions (lockdowns). This general COVID-19 pandemic response of imposing lockdowns, however, neglects to factor in non-fatal consequences leading to disruption socio-economic wellbeing of the society at large. The economy in most African countries can no longer sustain lockdown restrictions. Some studies have indicated that a hard lockdown statistical value of the extra lives saved would be dwarfed by its long-term cost. At the same time not responding to the threat of the pandemic will cost lives and disrupts the social fabric. This paper proffers ways to mitigate the both and advocate for better policymaking that addresses specific challenges in defined communities thus yield higher population welfare.


Assuntos
Vacinas contra COVID-19/provisão & distribuição , COVID-19/prevenção & controle , Tecnologia Digital , Política de Saúde , África , COVID-19/economia , Humanos , Formulação de Políticas , Quarentena/economia , Fatores Socioeconômicos , Vacinação/estatística & dados numéricos
2.
MEDICC Rev ; 23(3-4): 15-20, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34516532

RESUMO

The COVID-19 pandemic has had an impact worldwide with regions experiencing varying degrees of severity. African countries have mounted different response strategies eliciting varied outcomes. Here, we compare these response strategies in Rwanda, South Africa and Zimbabwe and discuss lessons that could be shared. In particular, Rwanda has a robust and coordinated national health system that has effectively contained the epidemic. South Africa has considerable testing capacity, which has been used productively in a national response largely funded by local resources but affected negatively by corruption. Zimbabwe has an effective point-of-entry approach that utilizes an innovative strategic information system. All three countries would benefit having routine meetings to share experiences and lessons learned during the COVD-19 pandemic.

4.
Pan Afr Med J ; 39: 111, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34512847

RESUMO

COVID-19 has impacted health systems globally with varying impacts across regions. In Zimbabwe, a country with perennial problems of shortage of healthcare workers and resources, the pandemic has caused substantial strain on the public health system. The ability to share experiences on what has worked and what has not can be valuable as scientists, policymakers, and others determine steps forward and reflect backward to determine lessons learned in the pandemic response. We describe the setup and function of a COVID-19 rapid response team in the context of a limited resource setting. The response had to be tailored to make maximal use of the resources available and manage the outbreak. In this article, we share notes from the field and discuss the process of setting up a rapid response protocol in a limited resource provincial hospital, the challenges encountered, improvised interventions and recommendations for managing a COVID-19 resurgence and future similar pandemics.


Assuntos
COVID-19/terapia , Atenção à Saúde/organização & administração , Equipe de Respostas Rápidas de Hospitais/organização & administração , Atenção à Saúde/economia , Pessoal de Saúde/organização & administração , Equipe de Respostas Rápidas de Hospitais/economia , Humanos , Zimbábue
5.
J Infect Dev Ctries ; 15(7): 910-12, 2021 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-34343114

RESUMO

Confirmed new cases of Coronavirus disease 2019 (COVID-19) have accelerated in Sub-Saharan Africa against a backdrop of fragile health systems, a high burden of comorbidities and socioeconomic instability. The context makes the region particularly vulnerable to the virus and its impact. As cases escalate, the need to tailor-make COVID-19-related response strategies to the African context is imperative. This paper aims to discuss key considerations on the public health response to the pandemic and its intersection with ethics and human rights. With this perspective, we bring attention to the conflict between healthcare workers' obligations and patient rights under the unclear policy and regulatory frameworks and the application of restrictive measures in the context of poverty. The indirect effects of the pandemic on already existing health problems are also highlighted. We appeal to the African States to establish appropriate systems which integrate human rights-based approaches to COVID-19 response. These systems should be ethically sound systems and ensure no-one is left behind in terms of testing, access to therapeutics and vaccination, and social protection; based on lessons learned over the past 12 months of the pandemic's presence in SSA, and patterns emerging across the globe.


Assuntos
COVID-19/psicologia , Pessoal de Saúde/psicologia , Direitos Humanos/ética , Direitos Humanos/legislação & jurisprudência , Saúde Pública , África ao Sul do Saara/epidemiologia , COVID-19/epidemiologia , Comorbidade , Atenção à Saúde , Política de Saúde/legislação & jurisprudência , Humanos , Pobreza
6.
Public Health Pract (Oxf) ; 2: 100070, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34173586

RESUMO

The easing of COVID-19 restrictions in southern Africa, including Zimbabwe, has seen most countries reopening schools for face-to-face learning. In this letter we discuss the paradox of reopening schools in the COVID-19 era and proffer recommendations for safe learning environments.

7.
J Acquir Immune Defic Syndr ; 87(Suppl 1): S17-S27, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34166309

RESUMO

BACKGROUND: Conducting HIV surveys in resource-limited settings is challenging because of logistics, limited availability of trained personnel, and complexity of testing. We described the procedures and systems deemed critical to ensure high-quality laboratory data in the population-based HIV impact assessments and large-scale household surveys. METHODS: Laboratory professionals were engaged in every stage of the surveys, including protocol development, site assessments, procurement, training, quality assurance, monitoring, analysis, and reporting writing. A tiered network of household, satellite laboratories, and central laboratories, accompanied with trainings, optimized process for blood specimen collection, storage, transport, and real-time monitoring of specimen quality, and test results at each level proved critical in maintaining specimen integrity and high-quality testing. A plausibility review of aggregate merged data was conducted to confirm associations between key variables as a final quality check for quality of laboratory results. RESULTS: Overall, we conducted a hands-on training for 3355 survey staff across 13 surveys, with 160-387 personnel trained per survey on biomarker processes. Extensive training and monitoring demonstrated that overall, 99% of specimens had adequate volume and 99.8% had no hemolysis, indicating high quality. We implemented quality control and proficiency testing for testing, resolved discrepancies, verified >300 Pima CD4 instruments, and monitored user errors. Aggregate data review for plausibility further confirmed the high quality of testing. CONCLUSIONS: Ongoing engagement of laboratory personnel to oversee processes at all levels of the surveys is critical for successful national surveys. High-quality population-based HIV impact assessments laboratory data ensured reliable results and demonstrated the impact of HIV programs in 13 countries.

8.
J Acquir Immune Defic Syndr ; 87(Suppl 1): S28-S35, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34166310

RESUMO

BACKGROUND AND SETTING: Electronic data capture facilitates timely use of data. Population-based HIV impact assessments (PHIAs) were led by host governments, with funding from the President's Emergency Plan for AIDS Relief, technical assistance from the Centers for Disease Control, and implementation support from ICAP at Columbia University. We described data architectures, code-based processes, and resulting data volume and quality for 14 national PHIA surveys with concurrent timelines and varied country-level data governance (2015-2020). METHODS: PHIA project data were collected through tablets, point-of-care and laboratory testing instruments, and inventory management systems, using open-source software, vendor solutions, and custom-built software. Data were securely uploaded to the PHIA data warehouse daily or weekly and then used to populate survey-monitoring dashboards and return timely laboratory-based test results on an ongoing basis. Automated data processing allowed timely reporting of survey results. RESULTS: Fourteen data architectures were successfully established, and data from more than 450,000 participants in 30,000 files across 13 countries with completed PHIAs, and blood draws producing approximately 6000 aliquots each week per country, were securely collected, transmitted, and processed by 17 full-time equivalent staff. More than 25,600 viral load results were returned to clinics of participants' choice. Data cleaning was not needed for 98.5% of household and 99.2% of individual questionnaires. CONCLUSION: The PHIA data architecture permitted secure, simultaneous collection and transmission of high-quality interview and biomarker data across multiple countries, quick turnaround time of laboratory-based biomarker results, and rapid dissemination of survey outcomes to guide President's Emergency Plan for AIDS Relief epidemic control.

9.
J Acquir Immune Defic Syndr ; 87(Suppl 1): S67-S72, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34166314

RESUMO

BACKGROUND: In the population-based HIV impact assessment surveys, early infant diagnosis (EID) was provided to infants <18 months without a prior diagnosis. For the Namibia population-based HIV impact assessment (NAMPHIA), the GeneXpert platform was assessed for the feasibility of near POC EID testing compared with the standard Roche COBAS AmpliPrep/COBAS TaqMan (CAP/CTM) platform. Quality assurance measures and turnaround time were compared to improve EID results reporting. METHODS: NAMPHIA participants were screened for HIV exposure using Determine HIV-1/2 rapid test; samples reactive on Determine received EID testing on the GeneXpert instrument and Xpert HIV-1 Qual assay using whole blood. Results were confirmed at the Namibia Institute of Pathology using dried blood spots on the Roche CAP/CTM platform per national guidelines. RESULTS: Of the 762 screened infants, 61 (8.0%) were Determine-reactive and considered HIV-exposed. Of the 61 exposed infants, 2 were found to be HIV-infected whereas 59 were negative on both GeneXpert and Roche platforms, achieving 100% concordance. Average turnaround time was 3.4 days for the Xpert HIV-1 Qual assay, and average time from collection to testing was 1.0 days for GeneXpert compared with 10.7 days for Roche. No samples failed using GeneXpert whereas 1 sample failed using Roche and was repeated. CONCLUSION: Quality POC EID testing is feasible in a national survey through extensive training and external quality assurance measures. The use of decentralized POC EID for national testing would provide rapid diagnosis and improve TATs which may prevent loss to follow-up, ensure linkage to care, and improve clinical outcomes for infants.

11.
PLoS One ; 16(5): e0250958, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33945546

RESUMO

BACKGROUND: Evidence on the spectrum of risk factors for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among front-line healthcare workers (HCWs) has not been well-described. While several studies evaluating the risk factors associated with SARS-CoV-2 infection among patient-facing and non-patient-facing front-line HCWs have been reported since the outbreak of the coronavirus disease in 2019 (COVID-19), and several more are still underway. There is, therefore, an immediate need for an ongoing, rigorous systematic review that continuously assesses the risk factors of SARS-CoV-2 infection among front-line HCWs. OBJECTIVE: Here, we outline a protocol to serve as a guideline for conducting a living systematic review and meta-analysis to examine the burden of COVID-19 on front-line HCWs and identify risk factors for SARS-CoV-2 infection in patient-facing and non-patient-facing front-line HCWs. METHODS: The protocol was developed and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The conduct of the proposed living systematic review and meta-analysis will primarily follow the principles recommended in the Centre for Reviews and Dissemination (CRD) guidance for undertaking systematic reviews in healthcare, and the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. The systematic literature searches will be performed using the EBSCOhost platform by searching the following databases within the platform: Academic search complete, health source: nursing/academic edition, CINAHL with full text, Embase, PubMed, MEDLINE, Science Direct databases, Google Scholar, and; also a search in the China National Knowledge Infrastructure and the World Health Organization library databases for relevant studies will be performed. The searches will include peer-reviewed articles, published in English and Mandarin language irrespective of publication year, evaluating the risk for testing positive for C0VID-19, the risk of developing symptoms associated with SARS-CoV-2 infection, or both, among front-line HCWs. The initial review period will consider articles published since the onset of COVID-19 disease to the present and then updated monthly. Review Manager (RevMan 5.3) will be used to pool the odds ratios or mean differences for individual risk factors where possible. Results will be presented as relative risks and 95% confidence intervals for dichotomous outcomes and mean differences, or standardised mean differences along with 95% confidence intervals, for continuous outcomes. The Newcastle-Ottawa Scale will be used to rate study quality, and the certainty of the evidence will be assessed by using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). The results of the living systematic review and meta-analysis will be reported per the PRISMA guidelines. DISCUSSION: Though addressing the needs of front-line HCWs during the COVID-19 pandemic is a high priority, data to inform such initiatives are inadequate, particularly data on the risk factor disparities between patient-facing and non-patient-facing front-line HCWs. The proposed living systematic review and meta-analysis anticipate finding relevant studies reporting risk factors driving the SARS-CoV-2 infection rates among patient-facing and non-patient-facing front-line HCWs, thus providing subsidies for public health interventions and occupational health policies. The study results will be disseminated electronically, in print and through conference presentation, and key stakeholder meetings in the form of policy briefs. TRAIL REGISTRATION: PROSPERO registration number: CRD42020193508 available for public comments via the link below https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193508).


Assuntos
COVID-19/diagnóstico , COVID-19/virologia , Bases de Dados Factuais , Pessoal de Saúde , Saúde do Trabalhador , Saúde Pública , Fatores de Risco , SARS-CoV-2/isolamento & purificação
12.
Disaster Med Public Health Prep ; : 1-6, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33867001

RESUMO

The risk of recurring coronavirus disease (COVID-19) resurgences that threaten Africa's health care systems, newly opened communities, schools, and businesses looms as communities abandon precautionary measures, such as mask-wearing, physical distancing, and regular handwashing. In this piece, we unpack the handling of both the first wave and subsequent resurgence in the context of 3 countries that are experiencing such a resurgence at the time of writing (December 2020): Israel, France, and the United Kingdom. While it is difficult to extrapolate on what to expect in South Africa, based on experience in these 3 countries, South Africa's preparedness for a COVID-19 resurgence should place emphasis on the role of expanded testing and isolation capacity, strengthening enforcement of adherence to non-pharmaceutical interventions, and protection of high-risk populations.

13.
Vaccines (Basel) ; 9(3)2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33809002

RESUMO

South Africa became one of the first African countries to receive the COVID-19 vaccine. As the rest of Africa prepares to receive COVID-19 vaccines, most countries in Africa have set up national-level coordination committees for developing national vaccination deployment plans. While the main focus of these committees has been on setting up strategies that facilitate the swift distribution of COVID-19 vaccines once they are available, the role of effective public health awareness should not be ignored. Countries must devise strategies on how best to enhance public understanding and curb misinformation about the vaccines. With this viewpoint, we unpack the threat of COVID-19 vaccine hesitancy and offer recommendations for COVID-19 vaccine communication strategies in the South African and Zimbabwean contexts.

14.
Public Health Pract (Oxf) ; : 100089, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33564751

RESUMO

Covid-19 cases and death are on the rise in Zimbabwe and other Southern African countries. This increase poses a major risk of outbreaks in institutions such as prisons and detention centres. Zimbabwe has a total of 46 prisons which are overcrowded and without adequate running water, hand sanitizers and masks for both prisoners and warden officers. Although the country has released some prisoners, it is still not enough to decongest the prisons and mitigate the Covid-19 risk. There is a need to further decongest the prisons, ensure facilities have adequate tap water and consider use of video and audio technology to minimize visitors to inmates.

15.
Clin Infect Dis ; 72(10): e667-e674, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32865204

RESUMO

Control of coronavirus disease 2019 (COVID-19) heavily relies on universal access to testing in order to identify who is infected; track them to make sure they do not spread the disease further; and trace those with whom they have been in contact. The recent surge in COVID-19 cases in Zimbabwe is an urgent national public health concern and requires coordinated efforts to scale up testing using the capacity already in existence in the country. There is a need for substantial decentralization of testing, investment in better working conditions for frontline health workers, and the implementation of measures to curb corruption within government structures.


Assuntos
COVID-19 , Pessoal de Saúde , Humanos , Saúde Pública , SARS-CoV-2 , Zimbábue/epidemiologia
16.
J Community Health ; 46(2): 245-250, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33106963

RESUMO

As with other countries globally, Rwanda has faced a recent outbreak of the coronavirus disease 2019 (COVID-19) against a backdrop of an HIV epidemic. At present, there is no successful cure or vaccine for both COVID-19 and HIV. People with underlying conditions, including HIV, are at increased risk of severe COVID-19 manifestations. This underscores the need to enhance the knowledge, attitudes, and practice of people living with HIV (PLWH) to protect this population against COVID-19. An institution-based cross-sectional study was conducted from August 31 to September 18, 2020 among 376 participants who were selected by a simple random sampling technique. A pretested and structured self-administered questionnaire was used to collect data. Quality scores were calculated as a measure of the participants' knowledge, attitudes, and practice (KAP) levels. The student t-test was used to compare continuous variables between low (<65%) and high (≥65%) KAP scores. The chi-square test was used to determine the association between KAP scores and categorical variables. All decisions on statistical tests were concluded at 5% level of significance. All statistical analysis was performed using STATA statistical package version 11.2 (STATA Corp., Texas, USA). Of the 376 participants, 363 (97%) obtained a high knowledge score, while more than a quarter of the participants (26%) had a poor attitude score, and the majority (90%) having a high practice score. There was no association between gender, age, place of residence, employment, or duration on ART and knowledge score. Employment status and duration on antiretroviral treatment (ART) were significantly associated with attitude scores (p = 0.004 and p = 0.013, respectively). Gender and duration on ART were significantly associated with practice scores (p = 0.02 and p = 0.012, respectively). There was a moderate positive correlation (r = 0.57) between knowledge and attitude scores, and knowledge and practice scores (r = 0.55). There was a strong positive correlation (r = 0.67) between attitude scores and practice scores. Health education programs tailored for PLWH and aimed at mobilizing and improving COVID-19-related knowledge, attitude, and practice should be prioritized in the Rwandan COVID-19 response.


Assuntos
Síndrome de Imunodeficiência Adquirida/psicologia , COVID-19/psicologia , Emprego/estatística & dados numéricos , Educação em Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , COVID-19/epidemiologia , Estudos Transversais , Epidemias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruanda , Inquéritos e Questionários
17.
Heliyon ; 6(10): e05378, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33163663

RESUMO

Objective: This study sought to collaborate with key stakeholders to reach a consensus regarding the predominant barriers preventing the uptake of HIV testing services (HTS) by men and co-create an acceptable educational program to improve the knowledge of HIV self-testing (HIVST) among men in Rwanda. Methods: We employed the nominal group technique to identify a consensus regarding the predominant barriers currently impeding the male uptake of HTS. The health education program content was guided by the ranked barriers. We applied Mezirow's Transformational Learning Theory for curriculum development. Results: Eleven key barriers currently impeding the male uptake of HTS were identified in the nominal group process. The stakeholders co-created an interactive, structured curriculum containing information on the health locus of control; HIV etiology, transmission, diagnosis, status disclosure benefits, care and treatment services; and an overview of the HIVST background and test procedure to address multiple barriers. Conclusion: Key stakeholders co-created a comprehensive health education program tailored to men, which integrates education about health beliefs, HIV/AIDS and HIVST. Further studies to assess the effectiveness of the program are needed. It is anticipated that the intervention will improve the uptake of HIVST among men in Kigali, Rwanda.

18.
Int J Infect Dis ; 100: 394-395, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32979586

RESUMO

Coronavirus disease 2019 (COVID-19) has challenged health systems worldwide. In Zimbabwe, the COVID-19 response has seen the diversion of human capital, equipment, and other resources that were meant for the HIV and tuberculosis (TB) programmes. In a country with one of the worst HIV and TB burdens globally, the authors discuss this public health dilemma of sustained HIV and TB services in the context of a new threat - COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por HIV/terapia , Pneumonia Viral/epidemiologia , Saúde Pública , Tuberculose/terapia , COVID-19 , Infecções por HIV/diagnóstico , Serviços de Saúde , Humanos , Pandemias , SARS-CoV-2 , Tuberculose/diagnóstico , Zimbábue
19.
Saf Health Work ; 11(3): 262-265, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32995051

RESUMO

Coronavirus disease 2019 (Covid-19) poses an important occupational health risk to health workers (HWs) that has attracted global scrutiny. To date, several thousand HWs globally have been reported as infected with the severe acute respiratory syndrome coronavirus 2 virus that causes the disease. It is therefore a public health priority for policymakers to understand risk factors for this vulnerable group to avert occupational transmission. A rapid review was carried out on 20 April 2020 on Covid-19 risk factors among HWs in PubMed, Google Scholar, and EBSCOHost Web (Academic Search Complete, CINAHL Complete, MEDLINE with Full Text, CINAHL with Full Text, APA PsycInfo, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition) and WHO Global Database. We also searched for preprints on the medRxiv database. We searched for reports, reviews, and primary observational studies (case control, case cross-over, cross-sectional, and cohort). The review included studies conducted among HWs with Covid-19 that reported risk factors irrespective of their sample size. Eleven studies met the inclusion criteria. Lack of personal protective equipment, exposure to infected patients, work overload, poor infection control, and preexisting medical conditions were identified as risk factors for Covid-19 among HWs. In the context of Covid-19, HWs face an unprecedented occupational risk of morbidity and mortality. There is need for rapid development of sustainable measures that protect HWs from the pandemic.

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