Recherche Clinique (Clinical Research) - Antibioclic Afrique, un outil électronique d'aide à la décision clinique pour la prise en charge du COVID-19 en Afrique de l'Ouest Antibioclic Afrique, an electronic clinical decision support system for the management of COVID-19 in West Africa

The COVID-19 pandemic continues to spread, particularly in Africa, and a rapid increase in cases in many African countries is to be feared. On July 23, 2020, more than 114 000 cases and 1782 deaths have been reported in West Africa. Côte d'Ivoire and Senegal are among the most affected countries with 15 000 cases in Côte d'Ivoire and 9300 cases in Senegal. In order to control the epidemic, it is necessary to intervene at all levels of medical management, including primary care and working with healthcare workers who are among the most important actors in the epidemic response. However, primary care practitioners often practice in isolated settings without easy access to national recommendations, where and when they exist. It has been shown that electronic tools can help practitioners in their diagnostic and therapeutic decisions when caring for patients. However, according to the WHO, the distribution of electronic or digital health tools is still very limited in Africa. The overarching goal of this project is to improve the clinical management of COVID-19 patients in West Africa. For this, we propose to create, and make available, a free and independent electronic clinical decision support (CDSS) for the management of patients suspected or confirmed with SARS-CoV-2 infection: Antibioclic Afrique. Antibioclic Afrique would enable primary care clinicians to obtain personalized recommendations for diagnostic and therapeutic management in a few "clicks" adapted to each clinical situation. It would also advise them on the prevention aspects (organization of the health facility), and on the advice to give to patients. Several stages are essential for the sustainable success of this project: (i) developing an electronic tool to guide the clinical management of patients based on the architecture of Antibioclic which uses a systematic method to translate clinical recommendations into semi-formal decision trees (ii) adapting and tailoring it to the West African context in 5 different countries, taking into account the local context, the organization of the healthcare system and the diversity of health care facilities and training of prescribers (iii) implementing the CDSS guided by the use of theoretical frameworks and systematic strategies in implementation science in order to optimize the chances of success (iv) widely disseminating the tool by relying on the networks of the project investigators, of the ANRS, the African Society of Infectious Pathology (SAPI) and REACTing (v) monitoring and updating Antibioclic Afrique to provide decision support adapted to the current recommendations. This project will be associated with a research project which will aim to evaluate the implementation process, using methods drawn from implementation science. Implementation science is defined as "the scientific study of methods to promote the systematic adoption of research results and other evidence-based practices in routine practice and, thereby, to improve the quality and 'care efficiency'. These methods are based on an assessment of the local context, the definition of interventions adapted to this context, and the evaluation of the implementation process. This methodology will aim to optimize the decision support tool by its adaptation, its usefulness, its efficiency, and its cost (development and implementation costs, the tool being free), and especially its sustainable use by primary care clinicians in West Africa. The scientific information gathered during this project will feed knowledge on the implementation of electronic decision support tools (i) in primary care (ii) in West Africa and (iii) in a pandemic context.