The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Les approches familiales en intervention précoce : repères pour guider les interventions et soutenir les familles dans les programmes d’intervention pour premiers épisodes psychotiques (PPEP)

Il existe désormais un large consensus sur l’utilité des approches familiales dans les programmes d’intervention précoce en matière de psychose. L’évolution des connaissances sur les premières psychoses et le développement des interventions familiales ont grandement influencé la perception à l’égard des familles dans le processus de rétablissement. Objectifs Cet article propose un état des connaissances des pratiques en intervention familiale en posant un regard sur l’implication des familles en intervention précoce. Les connaissances issues du parcours des familles constituent la base historique de l’article, alors que celles plus récentes sur les troubles psychotiques et les interventions familiales servent de fondement à son contenu. Les objectifs sont de : 1) documenter les impacts et les besoins spécifiques des familles lors d’un premier épisode psychotique (PEP) ; 2) rappeler les fondements des approches familiales ; 3) guider l’intervention familiale dans les programmes PEP ; 4) soulever les enjeux liés à l’implication des familles en intervention précoce.Méthode Les connaissances historiques relatives au développement des approches en intervention familiale en santé mentale ont été documentées à partir des travaux des pionniers du domaine de l’intervention familiale, alors que l’état des pratiques actuelles a fait l’objet d’une recension des écrits (modèles et approches d’interventions, efficacité des interventions, enjeux de l’intervention et de l’implication des familles, etc.). Les résultats issus d’études récentes, menées au Québec et ailleurs, posent un regard sur les modalités d’interventions et la contribution des familles dans les équipes d’intervention précoce. Les enjeux liés à l’établissement de pratiques collaboratives, au partage d’informations et au respect de la confidentialité en santé mentale sont abordés.Résultats Les connaissances issues de la recension des écrits et des travaux de recherche récents sont mises en relief avec le cadre de référence des Programmes d’interventions pour premiers épisodes psychotiques (Cadre PPEP, 2018) et les mesures du Plan d’action en santé mentale (PASM 2015-2020), de même qu’avec les guides internationaux de bonnes pratiques en intervention précoce. Elles permettent d’identifier les acquis et de dégager les moyens à mettre de l’avant afin de poursuivre le développement des pratiques en intervention familiale au Québec.Conclusion La reconnaissance du rôle incontournable des familles et de leur implication en intervention précoce comporte des défis. Si les interventions familiales ont démontré leur efficacité, tant pour la personne atteinte que pour sa famille, des actions concrètes doivent être mises en place pour soutenir l’implantation de ces pratiques et assurer leur pérennité dans les équipes pour premiers épisodes psychotiques.There is now broad consensus on the usefulness of family approaches in early intervention programs. The evolution of knowledge about early psychosis and the development of family interventions have greatly influenced the perception of families in the recovery process. Objectives This article proposes a state of knowledge of family intervention practices by looking at family involvement in early intervention. Knowledge from the family journey constitutes the historical basis of the article, while more recent knowledge about psychotic disorders and family intervention form the basis of the article’s content. The objectives are to: 1) document the specific impacts and needs of families during a first episode of psychosis (FEP); 2) review the main approaches in family intervention; 3) guide the application of family interventions in FEP programs and 4) raise issues related to family involvement in early intervention.Method Historical knowledge on the development of family intervention approaches in mental health was documented from the work of pioneers in the field of family intervention, while the state of current practices has been the subject of a literature review (intervention models and approaches, effectiveness of interventions, issues of intervention and family involvement, etc.). Results from recent studies conducted in Quebec and elsewhere provide an overview of intervention methods and the contribution of families in early intervention teams. Issues related to the establishment of collaborative practices, information sharing and respect for confidentiality in mental health are addressed.Results Knowledge from the literature review and recent research is highlighted in relation to the First Episode Psychosis Intervention Programs Framework (Cadre PPEP, 2018) and the Mental Health Action Plan measures (PASM 2015-2020), as well as to international best practice guidelines for early intervention. They identify what has been achieved as well as ways to move forward in order to continue developing family intervention practices in Quebec.Conclusion Recognition of the essential role of families and their involvement in early intervention presents challenges. While family interventions have demonstrated their effectiveness, both for the person with the disorder and for their family, actions must be taken to support the implementation of these practices and ensure their sustainability in early intervention teams

Patient partner perspectives on compensation: Insights from the Canadian Patient Partner Survey

Abstract Introduction There is a growing role for patients, family members and caregivers as consultants, collaborators and partners in health system settings in Canada. However, compensation for this role is not systematized. When offered, it varies in both type (e.g., one‐time honorarium, salary) and amount. Further, broad‐based views of patient partners on compensation are still unknown. We aimed to describe the types and frequency of compensation patient partners have been offered and their attitudes towards compensation. Methods This study uses data from the Canadian Patient Partner Study (CPPS) survey. The survey gathered the experiences and perspectives of those who self‐identified as patient partners working across the Canadian health system. Three questions were about compensation, asking what types of compensation participants had been offered, if they had ever refused compensation, and whether they felt adequately compensated. The latter two questions included open‐text comments in addition to menu‐based and scaled response options. Basic frequencies were performed for all questions and open‐text comments were analyzed through inductive qualitative content analysis. Results A total of 603 individuals participated in the CPPS survey. Most respondents were never or rarely offered salary (81%), honorarium (64%), gift cards (80%) or material gifts (93%) while half were offered conference registration and expenses at least sometimes. A total of 129 (26%) of 499 respondents reported refusing compensation. Of 511 respondents, half felt adequately compensated always or often, and half only sometimes, rarely or never. Open‐text comments revealed positive, ambivalent and negative attitudes towards compensation. Attitudes were framed by perceptions about their role, sentiments of giving back to the health system, feelings of acknowledgement, practical considerations, values of fairness and equity and accountability relationships. Conclusions Our findings confirm that compensation is not standardized in Canada. Half of survey respondents routinely feel inadequately compensated. Patient partners have diverse views of what constitutes adequate compensation inclusive of personal considerations such as a preference for volunteering, and broader concerns such as promoting equity in patient partnership. Organizations should attempt to ensure that compensation practices are clear, transparent and attentive to patient partners' unique contexts. Patient Contribution Two patient partners are members of the CPPS research team and have been fully engaged in all study phases from project conception to knowledge translation. They are co‐authors of this manuscript. The survey was co‐designed and pilot tested with patient partners and survey participants were patient partners

Partage d’informations et respect de la confidentialité : repères pour améliorer la qualité des services en santé mentale

Objectifs La collaboration entre les personnes proches aidantes (PPA) et les professionnels joue un rôle déterminant dans le rétablissement de la personne vivant avec un trouble mental. Cependant, les pratiques collaboratives entre les PPA et les professionnels se heurtent à des enjeux de confidentialité, particulièrement lorsqu’il est question de partager des informations de manière bidirectionnelle entre les acteurs impliqués. Ce faisant, ces enjeux nuisent à la qualité des services offerts en santé mentale.Méthode Une étude qualitative a permis de rencontrer 19 PPA et 19 professionnels en santé mentale de 2 régions du Québec afin d’identifier les enjeux liés au partage d’informations et au respect de la confidentialité à partir de leur perspective croisée. Des entretiens individuels semi-dirigés ont été réalisés auprès des 38 participants.Résultats La confidentialité et le refus de la personne vivant avec un trouble mental à consentir au partage d’informations demeurent des obstacles importants et actuels dans les pratiques en santé mentale. L’organisation des services en santé mentale devrait assurer une meilleure intégration des PPA dans les équipes afin qu’elles puissent contribuer au rétablissement de la personne et ainsi, recevoir tout le soutien et les informations dont elles ont besoin pour exercer leur rôle. Il ressort de l’étude que les PPA ont différents besoins d’information pour exercer leur rôle et accompagner la personne vivant avec un trouble mental, dont celui d’avoir des renseignements généraux et non confidentiels pour mieux soutenir cette dernière. Tout en respectant les droits fondamentaux et l’autonomie de la personne qui est libre de consentir ou non au partage d’informations la concernant, les professionnels et les PPA peuvent tout de même avoir des échanges et créer une alliance qui favorise l’établissement de collaborations et le rétablissement.Conclusion Cet article offre des repères afin de faciliter le dialogue entre les personnes vivant avec un trouble mental, les PPA et les professionnels et de les soutenir dans leurs actions en matière de partage d’informations et de respect de la confidentialité dans les pratiques en santé mentale. Ultimement, l’intention est de favoriser des pratiques collaboratives qui contribueront à améliorer la qualité des services en santé mentale.Objectives Collaboration between family caregivers and professionals plays a critical role in the recovery of the person living with a mental health disorder. However, collaborative practices between family caregivers and professionals are impeded by issues relating to confidentiality, particularly in connection with bidirectional information sharing between the parties involved. In doing so, these issues affect the quality of mental health services.Method A qualitative study was conducted with 19 family caregivers and 19 mental health professionals from 2 Quebec regions in order to identify issues related to information sharing and confidentiality from their combined perspective. The Photovoice method was used and individuals semi-directed interviews were conducted with the 38 participants.Results Confidentiality and the refusal of the person living with a mental health disorder to consent to share information remains important and current obstacles in mental health practises. The organization of mental health services should ensure better integration of family caregivers into care teams so that they can contribute to the person’s recovery and thus receive all the support and information they need to exercise their role. This study shows that family caregivers have different information needs in order to carry out their role and accompany the person living with a mental health disorder, including the need for general and non-confidential information to better support the person. While respecting the fundamental rights and autonomy of the person, who is free to consent or not to sharing information concerning him or her, professionals and family caregivers can still interact and create an alliance that promotes collaboration and recovery.Conclusion This article offers benchmarks to facilitate dialogue among people living with a mental health disorder, family caregivers and professionals, and to support their actions around information-sharing and respect for confidentiality in mental health practises. Ultimately, the intention here is to foster collaborative practices that will help improve the quality of mental health services

La pair-aidance pour soutenir le rétablissement en intervention précoce pour la psychose : enjeux autour de son implantation au Québec et dans la francophonie

Objectifs Décrire les différents enjeux entourant l’intégration des pairs aidants (PA) et pairs aidants famille (PAF) dans les programmes d’intervention précoce pour la psychose (PIPEP) : leurs rôles, les retombées de leurs interventions pour les patients, les membres de l’entourage et les équipes traitantes, ainsi que les défis et les facilitateurs de ce processus.Méthode Cet article corédigé avec des PA et PAF présente une description et discussion de l’expérience de l’implantation de la pair-aidance et pair-aidance famille au sein des PIPEP au Québec, mise en perspective par une recension des écrits de la littérature scientifique et de la littérature grise, publiée en français ou en anglais dans les 20 dernières années.Résultats Huit des 36 articles scientifiques et 2 des 14 publications de la littérature grise retenus portaient spécifiquement sur les PIPEP ; les autres, sur l’intervention en santé mentale. Ces publications mettent en contexte l’expérience illustrée, par les cliniciens, PA et PAF, entre autres, par des vignettes cliniques. Différentes modalités de PA ont démontré un impact positif chez les jeunes présentant un premier épisode psychotique (JPEP) : amélioration de l’estime de soi, de la qualité de vie et du bien-être émotionnel ; elle peut faciliter le processus de réadaptation et réduire les hospitalisations. La PAF permet de réduire la stigmatisation des troubles mentaux, de favoriser l’espoir et le sentiment d’appartenance, d’augmenter la connaissance de la maladie et son traitement et de promouvoir de meilleures stratégies d’adaptation par les membres de l’entourage. Néanmoins, de nombreux défis d’intégration des PA et PAF dans les équipes cliniques ont été identifiés : la planification et le financement de la mise en place des services, la définition de leurs rôles, la formation, la supervision clinique, etc. Ces défis doivent être rapidement identifiés et résolus afin d’optimiser les soins aux JPEP et aux membres de l’entourage. Différentes stratégies ont été proposées pour l’implantation réussie de la pair-aidance dans les PIPEP, qui demeure limitée au Québec et dans la francophonie. Elle nécessite la participation et le soutien de toutes les parties prenantes, notamment les professionnels de la santé, les gestionnaires et les décideurs.Conclusion La pair-aidance et la pair-aidance famille mettent en valeur l’expérience vécue en tant qu’expertise et reconnaissent l’apport des personnes atteintes de psychose et des membres de l’entourage comme sources de soutien et modèles de rétablissement. Cette perspective s’intègre bien à la philosophie préconisée par les PIPEP. Intervention prometteuse, mise de l’avant par différentes politiques et guides nationaux, elle gagnerait à être rapidement implantée à plus large échelle afin de rattraper le retard d’intégration dans les PIPEP du Québec et de la francophonie. Ceci permettrait d’étudier avec des devis de recherche plus rigoureux et des échantillons plus importants les impacts positifs décrits.Objectives To describe the different issues surrounding the integration of peer support workers (PSW) and family peer support workers (FPSW) into early intervention for psychosis services (EIS): their roles, the impacts of these interventions for patients, their families, and treatment teams, as well as the challenges and facilitators of this process.Method This article, co-authored with PSW and FPSW, presents a description and discussion of the experience of implementing peer support and family peer support in EIS in Québec, supported by a perspective of a review of the scientific and grey literature published in French or English in the last twenty years.Results Eight of the 36 scientific articles and two of the 14 grey literature publications selected were specific to early intervention for psychosis; the remainder were on mental health intervention. These publications put into context the experience described by clinicians, PSW and FPSW, and illustrated by clinical vignettes. Different modalities of peer support have demonstrated a positive impact on young people with early psychosis: it contributes to the improvement of self-esteem, quality of life, emotional well-being and can facilitate the rehabilitation process and reduce hospitalizations. Family peer support can reduce the stigma surrounding mental health problems, foster hope and a sense of belonging, increase knowledge of the illness and its treatment, and promote better coping strategies by family members. Nevertheless, many challenges have been identified during the integration of peer support and family peer support within clinical teams: planning and funding the implementation of services, defining their roles in EIS, training, clinical supervision, etc. These challenges need to be identified and addressed quickly in order to optimize care for youth and their families. Various strategies have been proposed for the successful implementation of peer support in EIS, which remains limited in Quebec and in the French-speaking world. It requires the participation and support of all stakeholders, including health professionals, managers and decision makers.Conclusion Peer support and family peer support emphasizes lived experience as expertise, recognizing the contribution of people with psychosis and their families as sources of support and models for recovery. This perspective fits well with the philosophy advocated by EIS. This promising intervention, which has been put forward by various national policies or guides, would benefit from being rapidly implemented on a larger scale in Quebec EIS and in the French-speaking world. This would make it possible to study the positive impacts described for service users and their families with more rigorous research designs and larger samples

Developing a Canadian evaluation framework for patient and public engagement in research: study protocol

Background: Patient and public engagement (PPE) in research is growing internationally, and with it, the interest for its evaluation. In Canada, the Strategy for Patient-Oriented Research has generated national momentum and opportunities for greater PPE in research and health-system transformation. As is the case with most countries, the Canadian research community lacks a common evaluation framework for PPE, thus limiting our capacity to ensure integrity between principles and practices, learn across projects, identify common areas for improvement, and assess the impacts of engagement. Objective: This project aims to build a national adaptable framework for the evaluation of PPE in research, by: 1. Building consensus on common evaluation criteria and indicators for PPE in research; 2. Defining recommendations to implement and adapt the framework to specific populations