Evaluating the introduction of COVID-19 oral antivirals through a test and treat program: outcomes from a cohort study in four African countries.

INTRODUCTION: Access to oral antivirals like nirmatrelvir/ritonavir to treat COVID-19 remains largely unavailable across Africa. Ghana, Malawi, Rwanda and Zambia, all members of the COVID Treatment QuickStart Consortium, leveraged existing infrastructure to rapidly commence COVID-19 test-and-treat programs. We describe the individual-level impact within the cascade of care. METHODS: A retrospective cohort study was conducted in 36 facilities across four countries that captured data on SARS-CoV-2 positive individuals who were screened for treatment. Treatment criteria included being high-risk for severe COVID-19 disease progression, presenting within five days of symptom onset, and having mild-to-moderate COVID-19 disease severity; treatment eligibility was ultimately determined by trained healthcare workers. RESULTS: From 1941 participants, 50.2% were determined eligible while 65.2% were prescribed nirmatrelvir/ritonavir. Among those prescribed, 1265 (73.2%) received follow-up, among whom 99.4% confirmed treatment initiation and 97.6% completed the five-day treatment course. Two serious adverse events were reported, but neither was attributed to nirmatrelvir/ritonavir. CONCLUSIONS: These data are the first to suggest COVID-19 oral antiviral treatment can be quickly, efficiently and safely deployed in lower- and middle-income countries, in parallel with implementation research. Programs rapidly integrated their COVID-19 response into existing health service infrastructure, allowing for decentralization and demonstrating that introducing newly developed diagnostics and treatment in government health systems is feasible in lower-resourced settings during health emergencies. Equitable and timely access to diagnostics and treatments is crucial to combat emerging global disease threats and achieve global health equity.

Duke Scholars

Author Cameron Robert Wolfe Medicine, Infectious Diseases