Improving Equity in Respiratory Disease Outcomes in Africa using Data-Driven Tools: EQUI-RESP-AFRICA

Aims. An interdisciplinary group of academics, policymakers, representatives of non-governmental organisations (NGOs), patients and civil society will implement a 4-year programme to address key respiratory diseases (RD) in five African countries where morbidity and mortality from RD are very large: Nigeria, Kenya, Cameroon, Cote d'Ivoire, and South Africa. The aim is to build capacity, conduct quality research and an intervention trial, and engage communities and policymakers to achieve demonstrable and equitable reductions in morbidity and mortality from RD through evidence-based improvements in prevention, diagnosis, treatment, interventions and policies. Background. Chronic obstructive pulmonary disease, pneumonia, asthma, influenza, tuberculosis, lung cancer and COVID-19 are all prevalent in Africa. Although they cause a very large burden on the population's health, there is limited health systems' capacity for prevention, diagnosis, and treatment. Furthermore, there are large inequities in the outcomes of these diseases, with the poorest with no access to care being affected the most. Design and Methods. In Year 1, we will: (i) map the landscape of respiratory medicine in partner countries through rapid reviews of the available literature and data; (ii) engage relevant in-country stakeholders; (iii) study patients' and providers' preferences and needs; (iv) identify research priorities using the CHNRI tool. In Years 2 and 3, we will: (i) conduct summer schools for capacity building in data science and machine learning/AI, in community engagement, and in advocacy and the use of tools - Equitable Impact Sensitive Tool (EQUIST) and Pathways to Survival tool (PATHS); (ii) assess national health system preparedness for emerging infections; (iii) identify bottlenecks for early response; (iv) assess oxygen capacity and security; (v) study adherence to international guidelines through cross-sectional observational studies; (vi) conduct qualitative studies to understand barriers to seeking care; (vii) study feasibility of delivering pulmonary rehabilitation programme through a randomised controlled trial. In Year 4, we will: (i) link evidence with policy using EQUIST and PATHS tools to improve equity in outcomes and identify bottlenecks that lead to morbidity and mortality from respiratory causes; (ii) hold a high-level meeting to prioritise implementation of equitable interventions that are appropriate to each African context and tailored to patients' needs. Community Engagement and Capacity Building. We assembled a team of social scientists and NGOs to engage communities, stakeholders and policymakers, building on the examples of the Pan-African Thoracic Society's initiative Methods in Clinical, Epidemiological and Operations Research (PATS MECOR), a network of community health NGOs in Cote d'Ivoire (FENOSCI), and the NGOs in Nigeria (AFRIDA, C21), Cameroon (CACSNA) and Kenya (AAOKENYA). They will be joined by a team of researchers of diverse backgrounds to build capacity through Summer Schools. We will conduct a survey of training needs in partner countries and respond using resources available from the NIHR RESPIRE Unit's platform and the Global Health Respiratory Network. Dissemination. We will disseminate the results through a dedicated project website, the International Society of Global Health, the Journal of Global Health, the Journal of the Pan-African Thoracic Society, collaborating NGOs, and mainstream and social media.