Rapid introduction of oral antivirals for COVID-19: implementation of a test and treat program in four African countries

Rapid introduction of oral antivirals for COVID-19: implementation of a test and treat program in four African countries

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Introduction: Despite availability of approved oral antivirals like nirmatrelvir/ritonavir to treat COVID-19 in high-income countries since 2021, access to these drugs remains largely unavailable across the African continent.Ghana, Malawi, Rwanda and Zambia, all members of the COVID Treatment QuickStart Consortium, leveraged existing infrastructure to be among the first African countries to rapidly commence a COVID-19 test-and-treat program through Quickstart-donated nirmatrelvir/ritonavir that arrived in country between December 2022 and April 2023.We describe here the first comprehensive review of the individual-level data collected from implementation research.Methods: A retrospective cohort study was conducted in 36 primary, secondary, and tertiary facilities across the four countries.All people testing positive for SARS-CoV-2 at study sites who were screened for treatment were included in the study.

Treatment criteria included high-risk for severe COVID-19 disease progression, presenting within five days of symptom onset, and mild-to-moderate COVID-19 disease severity; treatment eligibility was ultimately determined by trained healthcare workers.Baseline data were captured by these health care workers, who also conducted 10- and 30-day follow-ups to assess side effects and patient outcomes.Preliminary results are from data collected from the end of December 2022 through December 2023.Results: A total of 807 COVID-19 positive participants were included: 18% (n=149) from Ghana, 5% jilungin dreaming tea (n=42) from Malawi, 11% (n=90) from Rwanda, and 65% (n=526) from Zambia.57% (n=463) of participants were female, 67% (n=539) were 50 years or older, and 70% click here self-reported being vaccinated for COVID-19.

Approximately 81% of participants were eligible; 85% (n=685) of participants were prescribed nirmatrelvir/ritonavir.Among those prescribed, 59% (n=401) received follow-up, among whom 95% (n=381) confirmed treatment initiation and 95% (363/381) completed the 5-day course of treatment.Among those with non-missing data, 62% (412/666) were high-risk, 96% (650/676) presented with mild/moderate disease severity, and 95% (520/545) were within five days of symptom onset.Most frequent side effects included taste and gastrointestinal disturbance.No severe adverse events, including hospitalization or death, were reported.

Discussions: This data is the first to suggest COVID-19 treatment with an oral antiviral can be quickly, efficiently and safely deployed in lower resourced countries.Nirmatrelvir/ritonavir appears acceptable, evidenced by high uptake and adherence.There were also no severe adverse events reported, showing the safety of the drug in a generally young but high-risk population, consistent with previous research studies.Conclusion: Programs successfully integrated their COVID-19 response into existing health service delivery infrastructure, allowing for rapid roll-out and decentralization of test and treat programs, demonstrating that introducing diagnostics and new treatment in government health systems is feasible in lower resourced settings during health emergencies.Equitable and timely access to diagnostics and treatments across the globe is crucial to combat emerging disease threats.