The ‘syndemic’ of HIV and other factors and diseases like COVID-19 was a major topic at the International AIDS2020 Conference (8-10 July 2020) as discussed by Ambassador Deborah Birx, US Government AIDS Coordinator and Coranavirus Coordinator for the White House, in her keynote address. BroadReach issued this advice following the release of their observational data analysis at AIDS2020 on COVID-19 presumptive cases and comorbidities.
BroadReach’s research, Identifying high risk populations for targeted testing and rapid response for COVID-19, shows that people with comorbidities, such as HIV, TB, obesity and hypertension, are most likely to present as presumptive for COVID-19 at screenings. BroadReach conducted this important research in partnership with the Department of Health in Mpumalanga Province, South Africa. Research from the Western Cape in South Africa, also released at AIDS2020, revealed that people with TB and HIV have a two- to three-fold increased risk of dying from COVID-19, while virally suppressed HIV-positive individuals do not seem to have an increased risk of dying from COVID-19. Continuous HIV treatment adherence is therefore crucial as COVID-19 case numbers climb dramatically.
“During level five lockdown, we noticed a worrying drop in headcount at facilities where ARVs are administered. There has been some improvement but foot traffic at the facilities we support has dropped to 30 percent in some places,” says Dhirisha Naidoo, Deputy Chief of Party at BroadReach Healthcare. “If HIV patients miss appointments and don’t collect their medication, they run the risk of becoming virally unsuppressed, which weakens their immune system and heightens their COVID-19 risk.”
Naidoo says that once people drop off treatment, they can become resistant to the drugs, which means they must go onto a second or third-line treatment regimes, which is more invasive for the patient and more expensive for the government.
BroadReach developed a machine learning algorithm to predict which patients are likely to drop off antiretroviral (ARV) treatment before they default. BroadReach has utilised the Vantage ‘Patient Retention Solution’ since 2019, with an 80 percent confidence interval. To prepare for COVID-19, BroadReach ‘retrained’ the Patient Retention Model, adding specific COVID-19 risk indicators such as age, location and comorbidities.
“When COVID-19 hit our population, we knew technology would be instrumental to further protect at-risk populations,” says Paul Swanepoel, Senior Manager of Data Science at BroadReach Consulting. “We ran the algorithm across all patients on Vantage, our data-led platform. We identified over 70,000 patients with a statistically high risk of contracting a severe case of COVID-19 and sent education and support messaging to 500,000 HIV positive patients via SMS through our partner, access.mobile.
“The at-risk HIV patients include the elderly, or those suffering from hypertension, diabetes or TB. We further whittled it down to a group of 7,000 patients within the population BroadReach Healthcare directly supports. These individuals have receive specific supportive intervention from our colleagues working in the field and the Department of health. This is a continual example of AI and human intervention working together to save lives.”
BroadReach’s work is funded by PEPFAR within USAID’s Accelerating Programme Achievements to Control the Epidemic (APACE) programme, which aims to bring the HIV epidemic under control. A key programme goal is to identify HIV positive individuals, put them on treatment, and ensure they stay on treatment so that they remain virally suppressed. Working with the Department of Health in Kwa-Zulu Natal and Mpumalanga, BroadReach has supported the South African government to provide ARVs to nearly half a million South Africans – about 10 percent of everyone on treatment in the country.
Additionally, the group was instrumental in helping the first district in South Africa – Ugu in KwaZulu-Natal – to achieve the 90-90-90 (90 percent know their status, 90 percent are on ARVs, 90 percent achieve viral suppression) UNAIDS target towards HIV epidemic control.