It will take wide adoption of Living Systematic Reviews, collaboration, technology, innovation, and optimal diagnostics to strengthen how sub-Saharan Africa responds to future pandemics.

These sentiments echoed at the first REASSURED Diagnostics Symposium, which took place between 23 and 24 November at the Future Africa Institute at the University of Pretoria, under the theme: 'Post COVID-19 Research Trends organised by the REASSURED-d@UP research group'.

The Symposium saw internationally renowned leaders and experts in diagnostics, medicine and public health convening to reflect on the lessons learned during COVID-19. This provided a platform to exchange ideas on how to use these lessons to shape the planning for the threat of future pandemics and collaboratively chart the road ahead with local diagnostics researchers, developers, and users.  

Internationally acclaimed Professor Lehana Thabane, Vice-President of Research, McMaster University, St Joseph's Healthcare – Hamilton, reflected on the effectiveness of Living Systematic Reviews, adaptive platform trial designs, and collaborative approach to research that prevailed through the course of COVID-19. 

Prof Thabane called for the broad adoption of Living Systematic Reviews as a standard to provide care, describing them as the future of evidence synthesis. He conceded that Living Systematic Reviews were never heard of before the outbreak of COVID-19, lauding them for playing an essential role in facilitating continuous evaluation of emerging evidence. 

He added, "The use of Living Systematic Reviews shot up during the pandemic, and the growth continues. Many of these living reviews led to WHO guidelines on how to treat, manage or prevent COVID-19 infections and associated outcomes." 

Innovative trial designs

"Living Systemic Reviews are here to stay, not only in COVID-19 but in every disease. Living Systematic Reviews have now become the standard for evidence synthesis to inform policy and care decisions". 

He acknowledged innovative trial designs, such as platform trials, as a model to increase the efficiency of trials to deal with pandemics and other disease conditions. "We are now using platform trials for every disease because they allow us to increase the efficiency of how we run trials. The landscape is wide open, they were not done regularly in other diseases except in oncology, but now they are done because COVID-19 demonstrated that they could be done effectively", said Prof Thabane

He noted the need to address social inequities and lack of inclusion, highlighting that COVID-19 exposed social inequalities in research and knowledge translation. 

Kuhlula Maluleke, a PhD candidate in the School of Health Systems and Public Health, UP, conceded that poor communities struggle to access diagnostics services within healthcare facilities. "The challenge for the health sector in South Africa is to develop a unified health system capable of delivering quality healthcare to citizens efficiently; the major barrier to this is the large disparities in the spatial distribution of health services." 

Dr Tafadzwa Dzinamarira, Country Director for ICAP Zimbabwe, shared his knowledge about lessons learned from COVID-19 and their relevance to monkeypox. "COVID-19 has reinforced laboratory capacity in Africa. All African countries are now confirmed to have to have PCR machines which are also able to test for monkeypox." He acknowledged a need for the development, distribution, and access to rapid tests to strengthen the continent's fight against monkeypox. 

Postdoctoral Fellow at UP Dr Boitumelo Moetlhoa reiterated the need for point-of-care (POC) diagnostics in primary care to accommodate underprivileged patients who cannot afford lab-based diagnostic testing. "Long-standing re-emergence of infectious diseases is a challenge in Sub-Saharan Africa, and early detection of such diseases reduces transmission and a rise in untreated cases, therefore acceptability of REASSURED POC is thus required to enhance the quality of primary healthcare," she added. 

‘Diagnostic testing has been essential for personal and population health measures’

Speaking about the evolving role that nuclear medicine and molecular imaging can play in the management of COVID-19, Professor Mike Sathekge, Head of the Department of Nuclear Medicine at the University of Pretoria and Steve Biko Academic Hospital and CEO of NuMeRi, said various tracers are being used for cardiovascular sequelae, neurological sequelae, and thyroid sequelae. 

Professor Peter Nyasulu, who heads up the Division of Epidemiology and Biostatistics at Stellenbosch University, challenged everyone to think about the clinical biomarkers needed to predict long COVID. "The acute phase of COVID-19 is going away; however, it is leaving a huge range of other conditions that we will grapple with in the healthcare system that will overburden the healthcare system", he said.

"We need to understand the burden of long COVID-19 in African populations, so that we can know how to prepare our health system."

In his keynote address, Professor Paul Drain, Associate Professor in the Department of Global Health at the University of Washington, focused on the diagnostics of tuberculosis, HIV, and COVID-19. "Diagnostic testing has been essential for personal and population health measures. Over this last year, there has been rapid expansion and growth of home-based testing, which started with the outbreak of COVID-19, and now most homes in the United States have the diagnostic tests," he said. 

He highlighted the great strides achieved in point-of-care diagnostics and noted that there is a need for the development of POC diagnostic for viral load testing, adherence testing, drug resistance testing for HIV, and the need to move to urine-based POC TB tests. 

"We still need to diagnose more people with HIV and TB. The role we see for rapid diagnostic tests is facilitating treatment initiation delivered faster and hopefully improving retention in care." 

"We might improve patients' adherence along the way, and we have to make sure that the interventions are cost-effective," he concluded.  

The Symposium aimed to foster collaborative participation in efforts to enhance the development and implementation of POC diagnostics for resource-limited settings and underserved populations. The workshop sessions challenged diagnostic researchers, experts, and users to brainstorm ways to implement 4IRDignostic models at POC in South Africa. 

The REASSURED Diagnostics Symposium was proudly sponsored by the US Embassy’s US Partnership initiative project.