Implementation of evidence-based multiple focus integrated intensified TB screening to end TB (EXIT-TB) package in East Africa: a qualitative study.

INTRODUCTION: Tuberculosis (TB) remains a major cause of morbidity and mortality, especially in sub-Saharan Africa. We qualitatively evaluated the implementation of an Evidence-Based Multiple Focus Integrated Intensified TB Screening package (EXIT-TB) in the East African region, aimed at increasing TB case detection and number of patients receiving care. OBJECTIVE: We present the accounts of participants from Tanzania, Kenya, Uganda, and Ethiopia regarding the implementation of EXIT-TB, and suggestions for scaling up. METHODS: A qualitative descriptive design was used to gather insights from purposefully selected healthcare workers, community health workers, and other stakeholders. A total of 27, 13, 14, and 19 in-depth interviews were conducted in Tanzania, Kenya, Uganda, and Ethiopia respectively. Data were transcribed and translated simultaneously and then thematically analysed. RESULTS: The EXIT-TB project was described to contribute to increased TB case detection, improved detection of Multidrug-resistant TB patients, reduced delays and waiting time for diagnosis, raised the index of TB suspicion, and improved decision-making among HCWs. The attributes of TB case detection were: (i) free X-ray screening services; (ii) integrating TB case-finding activities in other clinics such as Reproductive and Child Health clinics (RCH), and diabetic clinics; (iii), engagement of CHWs, policymakers, and ministry level program managers; (iv) enhanced community awareness and linkage of clients; (v) cooperation between HCWs and CHWs, (vi) improved screening infrastructure, (vii) the adoption of the new simplified screening criteria and (viii) training of implementers. The supply-side challenges encountered ranged from disorganized care, limited space, the COVID-19 pandemic, inadequate human resources, inadequate knowledge and expertise, stock out of supplies, delayed maintenance of equipment, to absence of X-ray and GeneXpert machines in some facilities. The demand side challenges ranged from delayed care seeking, inadequate awareness, negative beliefs, fears towards screening, to financial challenges. Suggestions for scaling up ranged from improving service delivery, access to diagnostic equipment and supplies, and infrastructure, to addressing client fears and stigma. CONCLUSION: The EXIT-TB package appears to have contributed towards increasing TB case detection and reducing delays in TB treatment in the study settings. Addressing the challenges identified is needed to maximize the impact of the EXIT-TB intervention.

Rapid virtual training and field deployment for COVID-19 surveillance officers: experiences from Ethiopia

Rapid scale-up of surveillance activities is the key to successful coronavirus disease 2019 (COVID-19) pandemic prevention and mitigation. Ethiopia did not have a sufficient number of active surveillance officers for the public health COVID-19 response. Training of surveillance officers was needed urgently to fill the gap in the workforce needed. Subject-matter experts from the United States and Ethiopia developed applicable training modules including background on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), contact investigation, and communications. The training modules were delivered live in real-time via web-based virtual presentation. Seventy-seven health surveillance officers were hired, trained, and deployed in two weeks to assist with surveillance activities in Ethiopia. Electronic capacity building is needed in order to improve Web-based training in resource-limited settings where internet access is limited or unreliable. Web-based synchronously delivered course was an effective platform for COVID-19 surveillance training. However, strengthening public and private information technology capacity, literacy, and internet availability will improve Web-based education platforms in resource-limited countries.

Rapid virtual training and field deployment for COVID-19 surveillance officers: experiences from Ethiopia.

Rapid scale-up of surveillance activities is the key to successful coronavirus disease 2019 (COVID-19) pandemic prevention and mitigation. Ethiopia did not have a sufficient number of active surveillance officers for the public health COVID-19 response. Training of surveillance officers was needed urgently to fill the gap in the workforce needed. Subject-matter experts from the United States and Ethiopia developed applicable training modules including background on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), contact investigation, and communications. The training modules were delivered live in real-time via web-based virtual presentation. Seventy-seven health surveillance officers were hired, trained, and deployed in two weeks to assist with surveillance activities in Ethiopia. Electronic capacity building is needed in order to improve Web-based training in resource-limited settings where internet access is limited or unreliable. Web-based synchronously delivered course was an effective platform for COVID-19 surveillance training. However, strengthening public and private information technology capacity, literacy, and internet availability will improve Web-based education platforms in resource-limited countries.

Traditional medicines for COVID-19: Perspectives from clinical pharmacologists.

There has been high interest in the use of traditional medicines for COVID-19 from early in the course of the pandemic. Significant advances in the science of ethnopharmacology have helped to introduce chemical entities identified from natural sources into modern medicine. However, the wider integration of natural products into the modern drug discovery process will require enhanced collaboration amongst the pharmaceutical industry, academic research units, regulatory bodies, ethics review committees and local, regional, continental and international organizations. Revisiting this topic holds promise of benefit for both the current and future pandemics.

One health research ethics

Emerging and re-emerging infectious diseases (EIDs) present major threats to public health, global security, and economic development. Coronavirus disease 2019 (COVID-19) is the latest EID to demonstrate the devastation, suffering, and scale of death that an EID can cause. Pandemics involving emerging and re-emerging infectious agents and associated infectious diseases, climate change, urbanization, biodiversity loss and financial instability have been identified as the most critical global issues today (1). Close to three-quarters of today's EIDs are known to be of zoonotic origin (where infectious agents spread to humans from domestic or wild animals), and their frequency and economic impact are on the rise

Containment of COVID-19 in Ethiopia and implications for tuberculosis care and research.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has emerged as a global health and economic security threat with staggering cumulative incidence worldwide. Given the severity of projections, hospitals across the globe are creating additional critical care surge capacity and limiting patient routine access to care for other diseases like tuberculosis (TB). The outbreak fuels panic in sub-Saharan Africa where the healthcare system is fragile in withstanding the disease. Here, we looked over the COVID-19 containment measures in Ethiopia in context from reliable sources and put forth recommendations that leverage the health system response to COVID-19 and TB. MAIN TEXT: Ethiopia shares a major proportion of the global burden of infectious diseases, while the patterns of COVID-19 are still at an earlier stage of the epidemiology curve. The Ethiopian government exerted tremendous efforts to curb the disease. It limited public gatherings, ordered school closures, directed high-risk civil servants to work from home, and closed borders. It suspended flights to 120 countries and restricted mass transports. It declared a five-month national state of emergency and granted a pardon for 20 402 prisoners. It officially postponed parliamentary and presidential elections. It launched the 'PM Abiy-Jack Ma initiative', which supports African countries with COVID-19 diagnostics and infection prevention and control commodities. It expanded its COVID-19 testing capacity to 38 countrywide laboratories. Many institutions are made available to provide clinical care and quarantine. However, the outbreak still has the potential for greater loss of life in Ethiopia if the community is unable to shape the regular behavioral and sociocultural norms that would facilitate the spread of the disease. The government needs to keep cautious that irregular migrants would fuel the disease. A robust testing capacity is needed to figure out the actual status of the disease. The pandemic has reduced TB care and research activities significantly and these need due attention. CONCLUSIONS: Ethiopia took several steps to detect, manage, and control COVID-19. More efforts are needed to increase testing capacity and bring about behavioral changes in the community. The country needs to put in place alternative options to mitigate interruptions of essential healthcare services and scientific researches of significant impact.