Improving equity in respiratory disease outcomes in Africa using data-driven tools: National Institute of Health Care and Research's (NIHR) EQUI-RESP-AFRICA project.

Chronic obstructive pulmonary disease, pneumonia, influenza, asthma, tuberculosis, lung cancer, and COVID-19 are all prevalent in Africa, where they cause a very large burden on the population's health, but are managed by health systems with a limited capacity for prevention, diagnosis, and treatment. They are also underlaid by substantial inequities in outcomes, with the poorest who have no access to care being affected the most. An interdisciplinary group of academics, policymakers, representatives of non-governmental organisations (NGOs), patients, and civil society are implementing a programme to address key respiratory diseases (RD) in five African countries where morbidity and mortality from RD is 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 in order to achieve demonstrable and equitable reductions in morbidity and mortality from RD through evidence-based improvements in prevention, diagnosis, treatment, interventions, and policies. The EQUI-RESP-AFRICA project will map the landscape of respiratory medicine in partner countries through rapid reviews of the available literature and data; engage relevant in-country stakeholders; study patients' and providers' preferences and needs; identify research priorities using the Child Health and Nutrition Research Initiative method; and conduct summer schools for capacity building in data science and machine learning/artificial intelligence, in community engagement, and in advocacy for and the use of the Equitable Impact Sensitive Tool (EQUIST) and Pathways to Survival (PATHS) tool. The project will also assess national health system preparedness for emerging infections, identify bottlenecks for early response, assess oxygen capacity and security, study adherence to international guidelines, and conduct qualitative studies to understand barriers to seeking care. It will also explore the feasibility of delivering a pulmonary rehabilitation programme through a randomised controlled trial. Ultimately, the programme will link evidence with policy using the EQUIST and PATHS tools to improve equity in outcomes and identify bottlenecks that lead to morbidity and mortality from respiratory causes. Through high-level meetings, it will prioritise the implementation of equitable interventions that are appropriate to each African context and tailored to patients' needs. A team of social scientists and NGOs, joined by a team of researchers of diverse backgrounds, will engage communities, stakeholders and policymakers to build capacity through summer schools, and disseminate the results through a dedicated project website, the Journal of Global Health, the Journal of the Pan-African Thoracic Society, collaborating NGOs, and mainstream and social media.