ISARIC Regional Hubs
In 2020 ISARIC in collaboration with GOARN Research applied to Wellcome and FCDO UK for funds to support the pandemic response in low- and middle-income countries (LMICs) – ‘Enabling ISARIC Clinical Characterisation Protocol (CCP) roll out in LMICs’ [222048/Z/20/Z].
The approach taken was one of capacity building with a focus on starting to build out of ISARIC partners in Brazil, Ghana, Pakistan and the Philippines in the form of Clinical Research Regional Hubs.
The International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) regional hub leads Dr John Amuasi (African Hub), Dr Fernando Bozza (South American Hub), Professor Madiha Hashmi (South Asian Hub), and Doctors Janice Caoili and Muge Cevik (Southeast Asian Hub) coordinate all hub activities.
Learn more about our Regional Hub case studies below
African Hub, Ghana – a case study
Learn more about the African Regional Hub lead, Dr John Amuasi, here.
In the original grant proposal [222048/Z/20/Z], the African Hub anticipated setting up four countries in Africa. In 12-months the team has surpassed this expectation by operationalising an additional three countries, representing 28 research sites across seven African countries.
The African Regional Hub was quick to get on board with the ISARIC WHO CCP activities and has, in parallel with the Wellcome Grant [221012/Z/20/Z], which was separately secured via ALERRT, focused on developing local data scientists – building their programmatic skills and creating one aggregated dashboard across four research sites in Ghana.
The breadth of stakeholder engagement activities undertaken to ensure sign up of many African countries speaks for itself, as does the volume of data collected, which have been shared with the Ministry of Health and COVID-19 management teams through dynamic dashboards and regular reporting. All the member countries have been given the opportunity to develop and share dynamic results via a dashboard with their Ministry of Health through an openly shared R code. During COVID-19 pandemic, weekly PDF reports for Ghana were shared with the Ministry of Health COVID-19 Taskforce. Results have been presented at Scientific Conferences across Ghana and Cameroon.
South American Hub, Rio de Janeiro – a case study
Learn more about the South American Regional Hub lead, Dr Fernando Bozza, here.
In Brazil, the South American lead has made considerable headway in community engagement. The team have engaged with the favela of Complexo da Maré, a socially vulnerable community in Rio de Janeiro consisting of 140,000 inhabitants. An intervention combining communication, surveillance, and telehealth, with a strong community engagement component, was able to reduce the COVID-19 mortality and increase case detection in this large Rio de Janeiro community. These findings show that investment in community-based interventions may reduce mortality and improve pandemic control in vulnerable communities from LMICs.
The team have also established an ongoing follow-up programme that analysed data on approximately 600 post-COVID confirmed cases until May 2022. Research in this community of this magnitude has never been previously undertaken. The team’s community activities have been exceptionally valuable to the community; not only has there been an increase in the awareness of COVID-19 amongst the population, but also managed to increase the accessibility to vaccines. To that end, a substantial number of individuals have received their COVID-19 vaccine (93.4% coverage with 2 doses in adults in the community). The ISARIC WHO CCP has been operationalised throughout, and data shared for international collaborative analysis, including analysis to generate evidence into long term COVID-19 sequelae in different populations.
South Asian Hub, Pakistan – a case study
Learn more about the South Asian Regional Hub lead, Prof Madiha Hashmi, here.
Prior to the COVID-19 pandemic the South Asian Regional Hub Lead conducted the first comprehensive survey of critical care resources in Pakistan, which helped stakeholders with resource utilisation and plan for surges at the beginning of the pandemic. Through existing linkages embedded within the Pakistan Registry of Intensive CarE (PRICE) and since 2017, the South Asian Regional Hub Lead has been working with ISARIC around preparedness activities – an example of which is how the ISARIC WHO Case Report Form is embedded within the registry (PRICE).
The process of standardised data collection invisibly improves care by identifying gaps in patient management. Specifically, for their COVID-19 response – they saw within their network how regular reports created an informed ‘community of healthcare professionals’, who had access to data regarding outcomes of COVID-19 patients admitted to ICU.
PRICE has been instrumental in operationalising the WHO ISARIC Clinical Characterisation Protocol at the start of the COVID-19 pandemic and the global COVID-19 Therapeutic clinical Trial in Pakistan.
Southeast Asian Hub, Philippines – a case study
Learn more about the Southest Asian Regional Hub leads, Dr Janice Caoili and Dr Muge Cevik, here.
At the start of this grant [222048/Z/20/Z] this hub had no additional funding to cover research costs for research, patients and other staff including data collectors. Starting from almost scratch, they have been busy engaging with many stakeholders up and down the country, including identifying and speaking with prospective research sites. A dedicated coordinating centre has been established, along with a large research site which is fully up and running. Training is being delivered across a further 9 research sites, and through collaborations with the Philippine Society for Microbiology and Infectious Diseases (PSMID), they have convened a multi-institution, multi-centre COVID-19 Study Group.
Leveraging the existing experience gained during the period of this Wellcome Grant [222048/Z/20/Z], this hub aims to build capacity in six other sites which showed great enthusiasm running research studies during emergencies. During this study, guidance and know-how will be provided to other sites and capacity will be built for these to be able to independently run these types of studies.