ABSTRACT
There is a substantial increase in sexually transmitted infections (STIs) among men who have sex with men (MSM) globally. Unprotected sexual practices, multiple sex partners, criminalization, stigmatisation, fear of discrimination, substance use, poor access to care, and lack of early STI screening tools are among the contributing factors. Therefore, this study applied multilayer perceptron (MLP), extremely randomized trees (ExtraTrees) and XGBoost machine learning models to predict STIs among MSM using bio-behavioural survey (BBS) data in Zimbabwe. Data were collected from 1538 MSM in Zimbabwe. The dataset was split into training and testing sets using the ratio of 80% and 20%, respectively. The synthetic minority oversampling technique (SMOTE) was applied to address class imbalance. Using a stepwise logistic regression model, the study revealed several predictors of STIs among MSM such as age, cohabitation with sex partners, education status and employment status. The results show that MLP performed better than STI predictive models (XGBoost and ExtraTrees) and achieved accuracy of 87.54%, recall of 97.29%, precision of 89.64%, F1-Score of 93.31% and AUC of 66.78%. XGBoost also achieved an accuracy of 86.51%, recall of 96.51%, precision of 89.25%, F1-Score of 92.74% and AUC of 54.83%. ExtraTrees recorded an accuracy of 85.47%, recall of 95.35%, precision of 89.13%, F1-Score of 92.13% and AUC of 60.21%. These models can be effectively used to identify highly at-risk MSM, for STI surveillance and to further develop STI infection screening tools to improve health outcomes of MSM.
ABSTRACT
Aims: To identify virtual healthcare services and digital health technologies deployed in South Africa during coronavirus disease 2019 (COVID-19) and the challenges associated with their use. Methods: To determine the status of digital health utilization during COVID-19 in South Africa, the preferred reporting items for systematic reviews and meta-analyses model was used to perform a systematic and in-depth critical analysis of previously published studies in well-known and trusted online electronic databases using specific search keywords words that are relevant to this study. We selected published peer-reviewed articles available from the onset of COVID-19 to July 2021. Results: Total of 24 articles were included into this study. This study revealed that South Africa adopted digital technologies such as SMS-based solutions, mobile health applications, telemedicine and telehealth, WhatsApp-based systems, artificial intelligence and chatbots and robotics to provide healthcare services during COVID-19 pandemic. These innovative technologies have been used for various purposes including screening infectious and non-infectious diseases, disease surveillance and monitoring, medication and treatment compliance, creating awareness and communication. The study also revealed that teleconsultation and e-prescription, telelaboratory and telepharmacy, teleeducation and teletraining, teledermatology, teleradiology, telecardiology, teleophthalmology, teleneurology, telerehabilitation, teleoncology and telepsychiatry are among virtual healthcare services delivered through digital health technologies during COVID-19 in South Africa. However, these smart digital health technologies face several impediments such as infrastructural and technological barriers, organization and financial barriers, policy and regulatory barriers as well as cultural barriers. Conclusion: Although COVID-19 has invigorated the use of digital health technologies, there are still some shortcomings. The outbreak of pandemics like COVID-19 in the future is not inevitable. Therefore, we recommend increasing community networks in rural areas to bridge the digital divide and the modification of mHealth policy to advocate for the effective use of innovative technologies in healthcare and the development of sustainable strategies for resources mobilization through private-public partnerships as well as joining available international initiatives advocating for smart digital health.
ABSTRACT
Since the outbreak of COVID-19, the attention has now shifted towards universal vaccination to gracefully lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. Sub-Saharan Africa is experiencing an exponential increase of infections and deaths coupled with vaccines shortages, personal protective equipment, weak health systems and COVID-19 emerging variants. Some developed countries integrated telemedicine to reduce the impacts of the shortage of healthcare professionals and potentially reduce the risk of exposure, ensuring easy delivery of quality health services while limiting regular physical contact and direct hospitalization. However, the adoption of telemedicine and telehealth is still nascent in many sub-Saharan Africa countries. Therefore, this study reflects on progress made towards the use of telemedicine, virtual health care services, challenges encountered, and proffers ways to address them. We conducted a systematic literature review to synthesise literature on telemedicine in sub-Saharan Africa. The study revealed that telemedicine provides unprecedented benefits such as improving efficiency, effective utilization of healthcare resources, forward triaging, prevention of medical personnel infection, aiding medical students' clinical observation and participation, and assurance of social support for patients. However, the absence of policy on virtual care and political will, cost of sustenance of virtual health care services, inadequate funding, technological and infrastructural barriers, patient and healthcare personnel bias on virtual care and cultural barriers are identified as limiting factors to the adoption of virtual health care in many African health systems. To alleviate some of these barriers, we recommend the development of robust policies and frameworks for virtual health care, the inclusion of virtual care in the medical school curriculum, supporting virtual care research and development, increasing health funding, removing monopolisation of telecommunication services, developing of virtual health solutions that address eccentricities of African health systems.
