Developing Countries Clinical Trials Research Articles

Tracking SARS-CoV-2 introductions in Mozambique using pandemic-scale phylogenies: a retrospective observational study

From the start of the SARS-CoV-2 outbreak, global sequencing efforts have generated an unprecedented amount of genomic data. Nonetheless, unequal sampling between high-income and low-income countries hinders the implementation of genomic surveillance systems at the global and local level. Filling the knowledge gaps of genomic information and understanding pandemic dynamics in low-income countries is essential for public health decision making and to prepare for future pandemics. In this context, we aimed to discover the timing and origin of SARS-CoV-2 variant introductions in Mozambique, taking advantage of pandemic-scale phylogenies. We did a retrospective, observational study in southern Mozambique. Patients from Manhiça presenting with respiratory symptoms were recruited, and those enrolled in clinical trials were excluded. Data were included from three sources: (1) a prospective hospital-based surveillance study (MozCOVID), recruiting patients living in Manhiça, attending the Manhiça district hospital, and fulfilling the criteria of suspected COVID-19 case according to WHO; (2) symptomatic and asymptomatic individuals with SARS-CoV-2 infection recruited by the National Surveillance system; and (3) sequences from SARS-CoV-2-infected Mozambican cases deposited on the Global Initiative on Sharing Avian Influenza Data database. Positive samples amenable for sequencing were analysed. We used Ultrafast Sample placement on Existing tRees to understand the dynamics of beta and delta waves, using available genomic data. This tool can reconstruct a phylogeny with millions of sequences by efficient sample placement in a tree. We reconstructed a phylogeny (~7·6 million sequences) adding new and publicly available beta and delta sequences. A total of 5793 patients were recruited between Nov 1, 2020, and Aug 31, 2021. During this time, 133 328 COVID-19 cases were reported in Mozambique. 280 good quality new SARS-CoV-2 sequences were obtained after the inclusion criteria were applied and an additional 652 beta (B.1.351) and delta (B.1.617.2) public sequences were included from Mozambique. We evaluated 373 beta and 559 delta sequences. We identified 187 beta introductions (including 295 sequences), divided in 42 transmission groups and 145 unique introductions, mostly from South Africa, between August, 2020 and July, 2021. For delta, we identified 220 introductions (including 494 sequences), with 49 transmission groups and 171 unique introductions, mostly from the UK, India, and South Africa, between April and November, 2021. The timing and origin of introductions suggests that movement restrictions effectively avoided introductions from non-African countries, but not from surrounding countries. Our results raise questions about the imbalance between the consequences of restrictions and health benefits. This new understanding of pandemic dynamics in Mozambique can be used to inform public health interventions to control the spread of new variants. European and Developing Countries Clinical Trials, European Research Council, Bill & Melinda Gates Foundation, and Agència de Gestió d'Ajuts Universitaris i de Recerca.

United Kingdom–East and Southern Africa Partnership at the Forefront of Developing the First Ever Test that Measures Patient Tuberculosis Burden in Hours

Mycobacterium tuberculosis has caused tuberculosis (TB) in humans for at least 3 millennia, but the disease has evaded eradication efforts by all human civilisations despite promising technological advancements. The World Health Organization (WHO) has set a target of ending the TB epidemic by 2035. Going by the current rate of progress, it is estimated that it will take another 160 years to realise the WHO End TB Strategy’s target. Accelerating the eradication of TB will require effective tools for diagnosis, vaccines and medicines to treat the disease, and efficient implementation thereof. This presents a great opportunity for innovators in East Africa and the world over to chip in and develop the best technologies to end TB. With funding from the European and Developing Countries Clinical Trials Partnership (EDCTP), partnerships between the UK-based University of St Andrews and research institutions in East and Southern Africa have led to the development of the first ever test – the molecular bacterial load assay (MBLA) – that measures the number of TB bacteria in a patient and reveals if this number is declining as a patient progresses on treatment. Initial assay results are available within 4 hours. Real-time knowledge of patient mycobacterial burden and the effectiveness of prescribed medications are crucial for timely clinical decisions on patient management.

Beyond Evidence: The Moral Case for International Mental Health

Beyond Evidence: The Moral Case for International Mental Health