Digital Diagnostics for Epidemic Preparedness in Africa
Short solution summary:
This solution will maximize epidemic preparedness in Kenya through personalized mobile phone-based digitalization of diagnostic data to nudge appropriate healthcare behaviors and target funds to the right patients.
In what city, town, or region is your solution team based?Kisumu, Kenya
Who is the Team Lead for your solution?
Professor Tobias Rinke de Wit, Research Director of PharmAccess and Professor at the University of Amsterdam and Amsterdam Institute for Global Health and Development leading a team of scientists.
Which Challenge Area does your solution most closely address?Identify (Determine & limit the disease risk pool & spill over risk), such as: Genomic data to predict emerging risk, Early warning through ecological, behavioural & other data, Intervention/Incentives to reduce risk for emergency & spill over
What specific problem are you solving?
1 in 6 world citizens are African, versus only 1 in 30 global COVID-patients. To date, there are reportedly 4.4m COVID cases and 116k deaths in Africa. This low figure is due to a combination of factors: underreporting of mortality records, lack of diagnostic testing, low average population age, potential cross-protection through BCG vaccination and non-pathogenic corona infections, genetic factors, and different immune systems that result in an overall asymptomatic appearance. Actual figures will be significantly higher. A representative survey in Zambia in July 2020 predicted 0.5M COVID infections, while at that time only 5,000 (0.1%) were registered.
We can conclude that COVID-19 remains hidden in Africa. This results in Africans becoming lax, non-compliant to precautions, and governments taking uninformed and economically damaging measures. With massive immunodeficiency due to malnutrition, HIV, and malaria, hidden COVID infections will take longer time periods infecting patients. From research on the British mutants we know that this allows for the further development of dangerous SARS-CoV-2 mutants that could confer resistance to vaccines and herd immunity. Therefore, we see Africa running the risk of becoming the world’s reservoir of mutated SARS-CoV-2 strains that will represent a continuous threat to the world.
Who does your solution serve, and what needs of theirs does it address?
- We identified much fear amongst health staff to work and become infected. They felt unprotected, mentally/physically exhausted due to work conditions, stigma, lack of protection, information, and opportunity to get regularly tested. We paid lab technicians danger allowances to take nose swabs from patients. Staff needs mental support and capacity building in testing, counselling and infection prevention. COVID-DX offers full physical and mental protection of health staff. Staff was involved in developing the response, through studies performed by KEMRI scientists. Hundreds of interviews and focus groups were performed, after which tools were adapted and interventions customized. We collected feedback from African facilities on our SafeCare4Covid tool, quantifying their epidemic readiness.
- Febrile patients visiting facilities need rapid certainty about the cause of their fever and proper treatment and care. Their fever could be due to a COVID, malaria, or typhoid infection. Our solution offers appropriate, semi-real time point-of-care diagnosis to patients and providers to take immediate actions (from quarantine to antibiotic or antimalarial treatment)
- County policy makers and health managers are in dire need of reliable surveillance data on febrile diseases, to make informed decisions on spending health budgets. Our solution provides digitalized geo- and time-tagged management information for these stakeholders.
What is your solution’s stage of development?Growth: An initiative, venture, or organisation with an established product, service, or business/policy model rolled out in one or, ideally, several contexts or communities, which is poised for further growth
Please select all the technologies currently used in your solution:
What “public good” does your solution provide?
The proposed COVID-DX application provides invaluable information to various stakeholders. First of all to public sector health managers and policy makers. The COVID-DX dashboard provides semi-real time information on important issues, like incidence of COVID-19 and other febrile epidemic diseases, geographic location, specific target populations, types of symptoms, comorbidities, etc.
Moreover, COVID-DX provides management information on rush hours in providers (allowing for spreading of appointments), suboptimal performance rates of lab technicians through RDT digitalization upload error rates (allowing for targeted training), (over-)prescription behavior of clinicians (allowing for remedial actions), etc. The benefits of these public goods are obvious, with respect to increasing quality of care and at the same time decreasing costs for the healthcare system.
The COVID-DX dashboard has already proven its public good function by informing government key decision makers in Kisumu on their personal mobile phones through password-protected access. This function will be further enhanced through regular stakeholder meetings and feedback loops of policy makers/health managers’ required information into the dashboard.
How will your solution create tangible impact, and for whom?
Impact of COVID-DX will be on two levels: 1. Directly for healthcare workers and 2. Indirectly for patients. First is to create a safe COVID-free work environment at facilities by supporting workers and support staff (admin, reception, security). Support is provided physically (PPEs and regular rapid testing) and mentally (digital and psychological support). We increase trust of staff in safety at work, increased recognition of needs, therefore increased confidence, pleasure in work and subsequent better patient interactions. Impact will be measured, quantitatively and qualitatively. Quantitatively, we will record working hours, presence, absence, sick leave, etc. of staff. Qualitatively, we will regularly interview staff through KEMRI social science activity, supplemented with focus groups. Feedback from these studies will be incorporated in our SafeCare4Covid support tool, including its mental health module.
Better performance of healthcare staff immediately contributes to our second goal: better health services (including COVID) for patients, most of whom belong to underserved/vulnerable populations. We will monitor this quantitatively by track patient visit flows, which we expect to increase with trust. Qualitatively, patients will be assessed again by researchers with questionnaires on service experiences, complemented focus groups. Information collected will feedback into the COVID-DX intervention tool during regular cyclic updates.
How will you scale your impact over the next one year and the next three years?
COVID-DX is a medium-sized scaling project of an intervention that already had proof-of-principle. COVID-DX is well-embedded in the Kisumu Department of Health, and an increasing recognized tool to have semi-real time insights in the dynamics of Covid-19 disease in the county. Scaling of impact will be done in several dimensions:
- We will expand in Kisumu to 25 facilities in year 1 under the M-TIBA platform. Linkage to the M-TIBA platform in principle allows for expansion to all 1.2 million Kisumu citizens who are connected through this feature in Kisumu.
- We subsequently expand to 2 additional LREB counties in year 2, supported by M-TIBA or in independent solutions.
- The Kisumu governor, who chairs the Health Section of the Kenyan National Board of Governors will function as advocate/ambassador, informing his colleague governors and promoting COVID-DX for national usage (45 million citizens).
How are you measuring success against your impact goals?
Impact is monitored through the semi-real time dashboard. Key indicators are:
1. Build infrastructure to protect 3,000 healthcare workers and 500,000 patients from COVID-19 in 3 counties:
- Numbers of healthcare providers contracted
- Numbers of healthcare professionals trained (counselors, nurses, doctors, lab technicians)
- Numbers and percentages of Covid-19 cases identified through digitalized RDT
- Numbers and percentages of other febrile diseases/epidemics identified through digitalized RDT (malaria, typhoid)
- Numbers of PPEs and disinfectants dispensed
- Numbers of target patient populations covered by COVD-DX services
- Numbers of counseling services provided to healthcare staff and to patients
2. Build a surveillance model that monitors and evaluates unique data of the impact of the COVID 19 vaccinations
- Numbers of views of COVID-DX dashboard; numbers of individual users of dashboard
- Numbers of Covid-19 patients contacts traced and diagnosed
- Numbers of Covid-19 patients contacts traced and diagnosed
- Numbers of nucleic acid sequences generated; numbers of SARS-CoV-2 mutants identified\
- Numbers and percentages of breakthrough Covid-19 infections identified
3. Increase willingness for COVID-19 testing and vaccine willingness
- Develop communication and outreach strategies
- Conduct counseling sessions
4. Support Government’s in creating sound, evidence-based COVID-19 policies
- Numbers of stakeholder meetings with healthcare officials and policy decisions realized
In which countries do you plan to deploy your solution within the next 3 years?
What barriers currently exist for you to accomplish your goals in the next year and the next 3 years? How do you plan to overcome these barriers?
Important ones are indicated in conjunction with solutions offered by COVID-DX:
- Recording and administration of incident cases of Covid-19 in in Kenya is not optimal, requires several paper-based steps and is partly automated. COVID-DX allows for full automation of the entire patient trajectory.
- There is insufficient healthcare staff trained in correctly collecting nose-swabs for (rapid) Covid-19 testing. COVID-DX can serve as a basis for targeted (refresher) trainings.
- There is no mental support mechanism in place for healthcare workers. COVID-DX provides mental support through counseling activities and offering the potential to incorporate digital mental health chatbots.
- There are delays, financial challenges, capacity and technical problems in centrally testing for Covid-19 through KEMRI laboratories. COVID-DX empowers lower-tier healthcare providers and less trained healthcare staff to perform rapid testing and provide patients with almost immediate results and concomitant mitigation advice. Eventually, even self-testing is possible through COVID-DX.
- Cultural barriers to testing: stigma and denial. There is underreporting for many other diseases and conditions. COVID-DX normalizes rapid testing for COVID-19 through regularity and application with healthcare role models, the healthcare workers themselves to create safe environments in clinics. This will increase trust of patients and make them return to facilities for other (febrile) conditions.
What type of organisation is your solution team?Nonprofit
List any organisations that you are formally affiliated with or working for
The Kenian Medical Research Institute.
Why are you applying to The Trinity Challenge?
Trinity Challenge offers PharmAccess the opportunity to scale our solution to improve quality of care during this global health crisis and reach underserved populations.
Most importantly, Trinity Challenge will help PharmAccess address the issue of suboptimal recording and administration of incident cases of COVID-19. We are interested if you are able to leverage your network for the optimal implementation of COVID-DX, not only in Kenya, but also in other countries. We believe we have a unique and scalable PPP-model, fit for implementation in other African countries. The Trinity Challenge is a good platform for us to share our model and create new partnerships.
What organisations would you like to partner with, why, and how would you like to partner with them?
PharmAccess is affiliated with the Joep Lange Institute, also based in Amsterdam.
For scaling our solution, we'd like to further collaborate with actors such as Bill and Melinda Gates Foundation.
Google and Microsoft have capabilities that could strengthen the data analytics part of our proposal.
Academic institutions can further assist us in further evaluating our model and exchanging research insights, particularly around COVID-19 related research.