Linking Europe and sub-Saharan Africa in the COVID-19 era. Partnership and teleneurology

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Background and aims

Low patients' retention summarizes difficulties of chronic care programs in sub-Saharan Africa (SSA): about 50% of the patients are lost to follow up few years after initiating treatments hampering epilepsy and stroke management. COVID-19 care disruption can increase epilepsy and stroke mortality particularly among HIV+ patients - as HIV increases epilepsy and stroke risks. Teleneurology can contribute to limit care disruption in SSA.

Methods

Since 2008 Global Health Telemedicine (GHT) offers advices from European neurologists and education from remote to thousands of African health workers particularly of the Disease Relief through Excellent and Advanced Means (DREAM) health program. In 2019 the Italian Society of Neurology, the C.Besta Neurologic Institute and the Mariani Foundation joined the DREAM-GHT education program in basic neurology in Malawi and Central African Republic (CAR). The impact of the partnership can be measured

Results

In Malawi the DREAM program follows 17,280 patients (88% HIV+): the lost-to-follow up before and during COVID-19 were 1,3% and 1,04% respectively. The total number of GHT-teleconsultations with Africa dropped from 3095 in 2019 to 2047 in 2020, −33,9%. On the opposite teleneurology consultations in Malawi and CAR increased from 91 in 2019 to 141 in 2020, +54,9%; 72% were for epilepsy.

Conclusions

Partnerships supporting teleneurology break COVID-19-provoked-isolation to improve local health providers work; this favours patients' trust and retention. The combined effect can limit COVID-19 care disruption.

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