Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa.

In Sub-Saharan Africa, communicable and other tropical infectious diseases remain major challenges apart from the continuing HIV/AIDS epidemic. Recognition and prevalence of non-communicable diseases have risen throughout Africa, and the reimagining of healthcare delivery is needed to support communities coping with not only with HIV, tuberculosis, and COVID-19, but also cancer, cardiovascular disease, diabetes, and depression. Many non-communicable diseases can be prevented or treated with low-cost interventions, yet implementation of such care has been limited in the region. In this Perspective piece, we argue that deployment of an integrated service delivery model is an urgent next step, propose a South African model for integration, and conclude with recommendations for next steps in research and implementation. An approach that is inspired by South African experience would build on existing HIV-focused infrastructure that has been developed by Ministries of Health with strong support from the U.S. President's Emergency Response for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. An integrated chronic healthcare model holds promise to sustainably deliver infectious disease and non-communicable disease care. Integrated care will be especially critical as health systems seek to cope with the unprecedented challenges associated with COVID-19 and future pandemic threats.

Reopening Schools After a Novel Coronavirus Surge.

The coronavirus disease 2019 (COVID-19) pandemic shook the world in ways not seen since the pandemic influenza of 1918-1919. As of late August 2020, over 25 million persons had been infected, and we will see the global death toll exceed one million by the end of 2020. Both are minimum estimates. All segments of society have been drastically affected. Schools worldwide have been forced to close due to illness and absenteeism, transmission and risk to vulnerable members of the school community, and community concerns. The decision to reopen school during a pandemic will have a tremendous impact on children's safety, growth, and well-being. Not opening invites social isolation and suboptimal educational experiences, especially for youth whose computing assets and online access are limited and those with special needs. The opening has hazards as well, and the mitigation of these risks is the topic of this chapter. Opening schools requires careful considerations of benefits, risks, and precautions. Guiding principles for safety and strategic application of the principles in each educational niche are critical issues to consider during school reopening. The fundamental principles of disease control involve school-directed initiatives (physical distancing and mask use, hand/face and surface cleansing, administrative controls, engineering controls) and individual-level risk reduction approaches to maximize adherence to new guidelines. The school-initiated "top-down" approaches and the individual-level "bottom-up" approaches must be synergized, as no single method will ensure safety. We discuss how to effectively layer strategies in each educational space to increase safety. Since the vulnerability of children has been heightened during this pandemic crisis, we highlight the special considerations for mental health support that should be considered by schools. The safety principles, disease control strategies, and other critical issues discussed here will serve as a starting point for developing a safe, comprehensive, and feasible reopening plan.