Protocol for a pragmatic cluster randomised controlled trial to evaluate the effectiveness of digital health interventions in improving non-communicable disease management during the pandemic in rural Pakistan.

BACKGROUND: The COVID-19 pandemic has revealed gaps in global health systems, especially in the low- and middle-income countries (LMICs). Evidence shows that patients with non-communicable diseases (NCDs) are at higher risk of contracting COVID-19 and suffering direct and indirect health consequences. Considering the future challenges such as environmental disasters and pandemics to the LMICs health systems, digital health interventions (DHI) are well poised to strengthen health care resilience. This study aims to implement and evaluate a comprehensive package of DHIs of integrated COVID-NCD care to manage NCDs in primary care facilities in rural Pakistan. METHODS: The study is designed as a pragmatic, parallel two-arm, multi-centre, mix-methods cluster randomised controlled trial. We will randomise 30 primary care facilities in three districts of Punjab, where basic hypertension and diabetes diagnosis and treatment are provided, with a ratio of 1:1 between intervention and control. In each facility, we will recruit 50 patients who have uncontrolled hypertension. The intervention arm will receive training on an integrated COVID-NCD guideline, and will use a smartphone app-based telemedicine platform where patients can communicate with health providers and peer-supporters, along with a remote training and supervision system. Usual care will be provided in the control arm. Patients will be followed up for 10 months. Our primary indicator is systolic blood pressure measured at 10 months. A process evaluation guided by implementation science frameworks will be conducted to explore implementation questions. A cost-effectiveness evaluation will be conducted to inform future scale up in Pakistan and other LMICs. DISCUSSION: Our study is one of the first randomised controlled trials to evaluate the effectiveness of DHIs to manage NCDs to strengthen health system resilience in LMICs. We will also evaluate the implementation process and cost-effectiveness to inform future scale-up in similar resource constrained settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier-NCT05699369.

Increasing Effectiveness and Equity in Strengthening Health Research Capacity Using Data and Metrics: Recent Advances of the ESSENCE Mechanism.

Background: The ESSENCE on Health Research initiative established a Working Group on Review of Investments in 2018 to improve coordination and collaboration among funders of health research capacity strengthening. The Working Group comprises more than a dozen ESSENCE members, including diverse representation by geography, country income level, the public sector, and philanthropy. Objective: The overall goal of the Working Group is increased research on national health priorities as well as improved pandemic preparedness, and, ultimately, fewer countries with very limited research capacity. Methods: We developed a basic set of metrics for national health research capacity, assessed different models of coordination and collaboration, took a deeper dive into eight countries to characterize their national research capacity, and began to identify opportunities to better coordinate our investments. In this article, we summarize the presentations, discussions, and outcomes of our second annual (virtual) meeting, which had more than 100 participants representing funders, researchers, and other stakeholders from higher- and lower-income countries worldwide. Findings and conclusions: Presentations on the first day included the keynote speaker, Dr. Soumya Swaminathan, chief scientist of the World Health Organization (WHO), and updates on data and metrics for research capacity, which are critical to establish targets, road maps, and budgets. The second day focused on improving collaboration and coordination among funders and other stakeholders, the potential return on investment for health research, ongoing work to increase coordination at the country level, and examples of research capacity strengthening efforts in diverse health research areas from around the world. We concluded that an intentional data- and metric-driven approach to health research capacity strengthening, emphasizing coordination among funders, local leadership, and equitable partnerships and allocation of resources, will enhance the health systems of resource-poor countries as well as the world's pandemic preparedness.

Fortalecimiento de la investigación local para abordar la salud y los derechos sexuales y reproductivos de las personas migrantes de Venezuela y América Central

[EXTRACTO] La evidencia que surge de este número especial destaca las necesidades específicas de las personas migrantes latinoamericanas respecto a la respuesta de los sistemas de salud a la salud sexual y reproductiva y las enfermedades infecciosas. Si bien hay políticas relacionadas con la salud de las personas migrantes y refugiadas, y se observan esfuerzos para fortalecer los sistemas de salud en los países de acogida, las personas migrantes de América Latina aún enfrentan una gran cantidad de dificultades al recurrir a los sistemas de salud para atender sus necesidades de SDSR. La pandemia de COVID-19 exacerbó aún más estos desafíos. Se necesitan políticas de SDSR que puedan llevarse a la práctica para poder responder adecuadamente a las necesidades de las personas migrantes.

Strengthening locally led research to respond to the sexual and reproductive health and rights of migrants from Venezuela and Central America

[EXTRACT] The evidence emerging from this special issue highlights the specific needs of Latin American migrants with regards to health system response to sexual and reproductive health and infectious diseases. While policies relating to the health of ref- ugees and migrants and efforts to strengthen health systems in host countries exist, migrants in Latin America still face a myr- iad of challenges when navigating health systems in addressing their SRHR needs. The COVID-19 pandemic further exacer- bated these challenges. Specific SRHR actionable policies are needed to ensure the needs of migrants are fully met.

Fortalecimiento de la investigación local para abordar la salud y los derechos sexuales y reproductivos de las personas migrantes de Venezuela y América Central / Strengthening locally led research to respond to the sexual and reproductive health and rights of migrants from Venezuela and Central America

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Strengthening locally led research to respond to the sexual and reproductive health and rights of migrants from Venezuela and Central America

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Going virtual for research training during the COVID-19 pandemic and beyond: e-SORT IT.

The Structured Operational Research and Training Initiative (SORT IT) model has contributed to building research capacity and has produced evidence for improving public health program performance in countries with limited research capacity. The model involves hands-on mentorship and consists of three modules/weeks. It is recognized to be an innovative research capacity building model. In a world changed by COVID-19, where bringing people together is not viable, an innovative, interactive, web-based, knowledge-transfer platform (e-SORT IT) for virtual implementation of SORT IT modules was created. The platform design imitated the residential course as closely as possible with the same lectures, plenary sessions, and breakout rooms. Despite the challenges, the platform performed well and even though participants and mentors were located in eight different time zones, the course was successful; 90% of participants achieved their milestones and 10 manuscripts were successfully completed. Participant evaluation revealed a satisfaction level that was nearly equivalent to the residential module. However, mentor evaluation indicated a number of shortcomings including capacity building, professional networking, communication, engagement, and contribution by participants, as well as overall module success. In conclusion, COVID-19 stimulated the creation of the e-SORT IT platform that provided a functional alternative to the residential version. Despite the limitations of reduced capacity building and networking, the e-SORT IT platform should be considered a success - it delivered the goods. This is an example of innovation and flexibility, two attributes that are sorely needed to maintain activities during the pandemic and beyond.

People Who Inject Drugs and have tuberculosis: Opioid Substitution Therapy improves treatment outcomes in Ukraine.

INTRODUCTION: Opioid substitution therapy (OST) is one of the pillars of harm reduction strategies for People Who Inject Drugs (PWID). It should be an integral part of tuberculosis (TB) care to increase the uptake, compliance and effectiveness of treatment and also curtail risk behaviors. We aimed to compare TB treatment outcomes in relation to OST among PWID in six regions of Ukraine. METHODOLOGY: A retrospective cohort study using routine programmatic data from centers offering integrated TB and OST (December 2016 - May 2020). OST involved use of methadone or buprenorphine. TB treatment outcomes were standardized. RESULTS: Of 228 PWID (85% male) diagnosed with TB, 104 (46%) had drug-sensitive and 124 (64%) drug-resistant TB. The majority had pulmonary TB (95%), 64 (28%) were HCV-positive and 179 (78%) were HIV-positive, 91% of the latter were also on antiretroviral therapy. There were 114 (50%) PWID with TB on OST. For drug-sensitive TB (n=104), treatment success was significantly higher (61%) in those on adjunctive OST than those not on OST (42%, P<0.001). Similarly, for drug-resistant TB (n=124) treatment success was also significantly higher when individuals were on OST (43%) compared to when not on OST (26%, P<0.001). CONCLUSIONS: This operational research study shows that OST is associated with significantly improved treatment success in PWID and can contribute to achieving Universal Health Coverage and the WHO Flagship Initiative "Find.Treat.All. #End TB". We advocate for the scale-up of this intervention in Ukraine.

Breaking the paradigm: Optimized Case Finding multiplies tuberculosis detection among key populations in Ukraine.

INTRODUCTION: In 2018, there were 3 million "missed" tuberculosis (TB) cases globally, much of which was disproportionally concentrated among key populations. To enhance TB case-finding, an Optimized Case Finding (OCF) strategy involving all contacts within the social network of an index TB case was introduced in five regions of Ukraine. We assessed TB detection and linkage to TB treatment using OCF in key populations. METHODOLOGY: A cohort study using routine program data (July 2018 - March 2020). OCF empowers the index TB case to identify and refer up to eight close contacts within his/her social network for TB investigations. RESULTS: Of 726 index TB cases in key populations, 6,998 close contacts were referred for TB investigations and 275 were diagnosed with TB (183 drug-sensitive and 92 drug-resistant TB). The TB case detection rate was 3,930/100,000 and the Numbers Needed to Investigate to detect one TB case was 25. TB was most frequent among people who inject drugs and homeless groups. Compared to TB detection using routine household case finding within the general population (1,090/100,000), OCF was 3.6-fold more effective and when compared to passive case finding in the general population (60/100,000), OCF was 66 times more effective. 99% (273) of TB patients were linked to care and initiated TB treatment. CONCLUSIONS: The OCF strategy among key populations is very effective in identifying TB cases and involving them for treatment through the recruitment of the contacts from the risk social networks. We advocate to scale-up this case finding strategy in Ukraine and beyond.

La utilidad y el impacto de incorporar la investigación sobre implementación para mejorar la ejecución de los programas: perspectivas de América Latina y el Caribe

[Extract]. La incorporación de la investigación se realiza como una parte integrada y sistemática de la toma de decisiones y la formulación y ejecución de políticas en materia de salud. Implica una colaboración continua entre los encargados de las decisiones, los investigadores y las comunidades. La incorpo-ración de la investigación se centra en los cambios a nivel de los sistemas y arroja luz sobre los factores específicos de cada contexto que influyen en los programas, las políticas y las deci-siones sobre sistemas relacionados con la salud en el mundo real. En consecuencia, mejora el sentido de apropiación y la ejecución.

The value and impact of embedded implementation research: insights from Latin America and the Caribbean

[Extract]. Embedded research is carried out as an integrated and systematic part of health decision and policy making and implementation. It means continuous collaboration between decision makers, researchers, and communities. Embedded research focuses on systems-level challenges and illuminates context-specific factors for real-world health programs, policy and system decisions. It improves ownership and implementa-tion. With this in mind, a joint initiative between the Alliance for Health Policy and Systems Research (Alliance HPSR), the Pan American Health Organization (PAHO), and the World Health Organization (WHO) Special Programme for Research and Training in Tropical Diseases (TDR) issued an open call for researchers and policy and decision makers to identify chal-lenges requiring embedded research to accelerate progress towards the SDGs in the Latin American and Caribbean (LAC) region and provided technical cooperation throughout the pro-cess. Following an open call for applications and reviewing more than 200 research proposals, 13 teams from 11 low- and middle-income countries in the LAC region were selected from Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Guyana, Haiti, Paraguay, and Peru.

Politics of disease control in Africa and the critical role of global health diplomacy: A systematic review.

Background: Africa is facing the triple burden of communicable diseases, non-communicable diseases (NCDs), and nutritional disorders. Multilateral institutions, bilateral arrangements, and philanthropies have historically privileged economic development over health concerns. That focus has resulted in weak health systems and inadequate preparedness when there are outbreaks of diseases. This review aims to understand the politics of disease control in Africa and global health diplomacy's (GHD's) critical role. Methods: A literature review was done in Medline/PubMed, Web of Science, Scopus, Embase, and Google scholar search engines. Keywords included MeSH and common terms related to the topics: "Politics," "disease control," "epidemics/ endemics," and "global health diplomacy" in the "African" context. The resources also included reports of World Health Organization, United Nations and resolutions of the World Health Assembly (WHA). Results: African countries continue to struggle in their attempts to build health systems for disease control that are robust enough to tackle the frequent epidemics that plague the continent. The politics of disease control requires the crafting of cooperative partnerships to accommodate the divergent interests of multiple actors. Recent outbreaks of COVID-19 and Ebola had a significant impact on African economies. It is extremely important to prioritize health in the African development agendas. The African Union (AU) should leverage the momentum of the rise of GHD to (i) navigate the politics of global health governance in an interconnected world(ii) develop robust preparedness and disease response strategies to tackle emerging and reemerging disease epidemics in the region (iii) address the linkages between health and broader human security issues driven by climate change-induced food, water, and other insecurities (iv) mobilize resources and capacities to train health officials in the craft of diplomacy. Conclusion: The AU, Regional Economic Communities (RECs), and African Centres for Disease Control should harmonize their plans and strategies and align them towards a common goal that integrates health in African development agendas. The AU must innovatively harness the practice and tools of GHD towards developing the necessary partnerships with relevant actors in the global health arena to achieve the health targets of the Sustainable Development Goals.

The value and impact of embedded implementation research: insights from Latin America and the Caribbean

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