Tobias Floris Rinke de Wit

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• PhD
• Principal Investigator at Amsterdam Institute for Global Health and Development

Background Evidence on which hypertensive intervention is cost-effective is essential to inform strategy, policy development, practice, implementation, and resource allocation. Value-Based Care (VBC) is a healthcare delivery model that emphasizes improving patient outcomes while optimizing costs. It shifts the focus from the volume of services prov...

Africa faces again a new outbreak of mpox, heavily burdening the Democratic Republic of Congo (DRC). Factors such as biological and ecological changes in the virus, waning of immunity to smallpox, socio-economic challenges, and global economic strain are fueling this epidemic. To analyse the drivers of the mpox outbreak in DRC, review the internati...

An increasing number of people living with HIV (PLHIV) are failing treatment without HIV drug resistance in the drug target region. While sub-optimal adherence is likely the cause of treatment failure in many PLHIV, resistance emerging at non-canonical (HIV drug resistance mutations occurring outside the drug target site) drug target site sites is...

Young People Living with HIV (YPLHIV, 15–24 years) are an important demographic of Persons Living with HIV (PLHIV) globally and in Southern Africa. However, YPLHIV experience poor outcomes across the HIV diagnostic and treatment cascade due to multiple factors. We estimated the prevalence and determinants of HIV viral suppression in YPLHIV on antir...

In Ethiopia, dengue virus (DENV) infections have been reported in several regions; however, little is known about the genetic diversity of circulating viruses. We conducted clinical surveillance of DENV during the 2023 nationwide outbreak in Ethiopia. We enrolled patients at 3 sentinel hospital sites. Using reverse transcription PCR, we screened se...

Universal Health Coverage (UHC) aims to ensure all individuals have access to essential health services without financial hardship. Chronic diseases, like hypertension and diabetes, play a critical role in achieving UHC due to their lifelong management needs. This paper examines the implementation of a digital and mobile-based, patient-centered car...

Background International vertical health financing programmes risk functioning in parallel with existing domestic funding in low- and middle-income countries (LMICs), leading to inefficient service delivery and concomitant poor health outcomes. Aim We assessed the opportunities offered by digitalised diagnostics (ConnDx) to target and monitor heal...

Introduction In low- and-middle-income-countries (LMICs) like Ghana, universal access to quality healthcare remains a mirage and this undermines achievement of sustainable development goal (SDG) 3. The SafeCare Quality Improvement (QI) programme is an initiative of PharmAccess Foundation, a Netherlands-based non-governmental organisation (NGO). In...

Background Digital technologies can assess the quality of medicines in resource-challenged health facilities in a timely manner and ensure effective healthcare. Objectives This study assessed the quality of some non-communicable disease medicines, antimalarials, antibiotics, non-steroidal anti-inflammatory drugs and hematinics in selected healthca...

We sequenced Leishmania tropica genomes directly from eight human skin samples collected in a newly emerging focus of cutaneous leishmaniasis in Somali region, Ethiopia. We found a new variant with unique genomic signatures of drug resistance. Genomic homogeneity in the sampled population demonstrates the occurrence of a L. tropica outbreak

Little is known about the acute and long-term sequelae of COVID-19 and its pathophysiology in African patients, who are known to have a distinct immunological profile compared to Caucasian populations. . Here, we established proteomic signatures to define severe outcomes of acute COVID-19 and determined whether proteome signatures during the first...

Introduction Although wastewater-based epidemiology (WBE) successfully functioned as a tool for monitoring the coronavirus disease 2019 (COVID-19) pandemic globally, relatively little is known about its utility in low-income countries. This study aimed to quantify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater, estim...

Antimicrobial resistance is a growing global concern exacerbated by the scarcity of new medications and resistance to current antibiotics. Microbes from unexplored habitats are promising sources of natural products to combat this challenge. This study aimed to isolate bacteria producing secondary metabolites and assess their antimicrobial efficacy...

In Sub-Saharan Africa, female entrepreneurs are well-represented in the healthcare sector but face significant challenges in accessing financial services. Digital financing technologies have the potential to close this gender-gap. This study aimed to assess the readiness, perspectives and gender disparities in (digital) loan characteristics among K...

Low- and middle-income countries (LMICs) house 66% of all hypertension patients, many of whom are undertreated, leading to severe health risks and higher healthcare costs. This study examined the required investments to improve hypertension control in Lagos, Nigeria, using real-world medical records and cost data. We found that both adherence to co...

Purpose Understanding the technical efficiency of health facilities is essential for an optimal allocation of scarce resources to primary health sectors. The COVID-19 pandemic may have further undermined levels of efficiency in low-resource settings. This study takes advantage of 2019 and 2020 data on characteristics of health facilities, health se...

Background More than 80% of the global premature mortality from noncommunicable diseases (NCDs) occurs in low- and middle-income countries (LMICs). Nigeria, like most LMICs, has limited capacity to respond to diabetes and hypertension. As the Lagos State government accelerates the rollout of its mandatory health insurance, Lagos State Health Scheme...

Background Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hyper...

Background Since 1964, healthcare in Zanzibar has been funded by the government through taxes and is free for all at all points of care. As this system is financially unsustainable, Zanzibar’s healthcare system is undergoing a reform. The current inadequate funding allocation and poor adherence to the referral system lead to an inefficient health s...

42 In Ethiopia, dengue virus (DENV) infections have been reported in several regions, however, little 43 is known about the circulating genetic diversity. Here, we conducted clinical surveillance for 44 DENV during the 2023 nationwide outbreak and sequenced DENV whole genomes for the first 45 time in Ethiopia. We enrolled patients at three sentinel...

Background Hypertension remains a major public health concern in low and middle-income countries as most hypertensive patients are not adequately treated, and improper lifestyle modification and expensive and inadequate antihypertensive medications are among the few of the challenges that hinder effective hypertension management. Evidence on which...

Background Universal antiretroviral therapy (ART) has led to improved treatment outcomes in personsliving with HIV (PLHIV). Adherence to ART is required to achieve viral suppression. Realtime medication monitoring (RTMM) based digital adherence tools (DATs) could be effectivein improving ART adherence and viral suppression in PLHIV. Objectives The...

Summary Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data...

Background Despite previous experience with epidemics, African healthcare systems were inadequately prepared and substantially impacted by the coronavirus disease 2019 (COVID-19) pandemic. Limited information about the level of COVID-19 preparedness of healthcare facilities in Africa hampers policy decision-making to fight future outbreaks in the r...

Despite previous experience with epidemics, African healthcare systems were inadequately prepared and substantially impacted by the coronavirus disease 2019 (COVID-19) pandemic. Limited information about the level of COVID-19 preparedness of healthcare facilities in Africa hampers policy decision-making to fight future outbreaks in the region, whil...

Objective This study investigated the association of plasma microRNAs before and during antiretroviral therapy (ART) with poor CD4 ⁺ T-cell recovery during the first year of ART. Design MicroRNAs were retrospectively measured in stored plasma samples from people with HIV (PWH) in sub-Saharan Africa who were enrolled in a longitudinal multicountry...

Background International vertical (disease specific) health financing programs risk functioning in parallel with existing domestic funding in low- and middle-income countries (LMIC)s, leading to inefficient service delivery and concomitant poor health outcomes. There is a need to reduce these inefficiencies and create new public-private opportuniti...

Objective There is a need to reduce inefficient service delivery caused by parallel financing streams. In this paper we aim to assess the opportunities offered by digitalized diagnostics to target and monitor health funds to those in need objectively and transparently. Methods In this study we used the malaria case to demonstrate the ConnDx process...

Background HIV services in Tanzania are facility‐based but facilities are often overcrowded. Differentiated care models (DCM) have been introduced into the National Guidelines. We piloted a Community Health Worker (CHW)‐led HIV treatment club model (CHW‐DCM) in an urban region, and assessed its effectiveness in comparison to the standard of care (S...

Background Adherence to treatment is a challenge to people living with HIV (PLHIV). Therefore, interventions are highly needed to assist PLHIV in adhering well to medication. Digital adherence tools (DAT) that offer real-time intervention are promising due to their ability to timely detect non-adherence and provide an opportunity for counselling. W...

Optimal adherence (>95%) to antiretroviral treatment (ART) remains a challenge among children and adolescents living with HIV (CALHIV). Digital adherence tools (DAT) with reminder cues have proven feasible among adult people living with HIV (PLHIV), with some concerns about the risk of HIV status disclosure. We aimed to assess the needs, contents a...

Introduction Antiretroviral therapy (ART) monitoring using viral load (VL) testing is challenging in high‐burden, limited‐resources settings. Chemokine IP‐10 (interferon gamma‐induced protein 10) strongly correlates with human immunodeficiency virus (HIV) VL. Its determination could serve to predict virological failure (VF) and to triage patients r...

Introduction Antiretroviral therapy (ART) monitoring using viral load (VL) testing is challenging in high-burden, limited-resources settings. Chemokine IP-10 (interferon gamma-induced protein 10) strongly correlates with human immunodeficiency virus (HIV) VL. Its determination could serve to predict virological failure (VF) and to triage patients r...

Background: B-cell hypo-responsiveness has been associated with intestinal parasitic co-infection. The effect of parasite co-infection on antibody response to SARS-CoV-2 is unknown. Here, we aimed to determine antibody response to SARS-CoV-2 among COVID-19 patients co-infected with intestinal parasites and those without parasite co-infection. Metho...

Background People living with HIV (PLHIV) have to take lifelong antiretroviral treatment, which is often challenging. Young people living with HIV (YPLHIV) have the lowest viral load suppression rates in Malawi and globally, mostly due to poor treatment adherence. This is a result of complex interactions of multiple factors unique to this demograph...

Background: Epidemics can cause significant disruptions of essential health care services. This was evident in West-Africa during the 2014-2016 Ebola outbreak, raising concerns that COVID-19 would have similar devastating consequences for the continent. Indeed, official facility-based records show a reduction in health care visits after the onset...

Background HIV prevalence in Tanzania is still high at 4.7% among adults. Regular HIV testing is consistently advocated in the country to increase the level of awareness of HIV status, thus contributing to national HIV prevention. We report findings from three years of implementation of an HIV Test and Treat project utilizing provider-initiated and...

Purpose To evaluate the role of C-reactive protein (CRP) in predicting severe COVID-19 patients. Methods A prospective observational cohort study was conducted from July 15 to October 28, 2020, at Kuyha COVID-19 isolation and treatment center hospital, Mekelle City, Northern Ethiopia. A total of 670 blood samples were collected serially. SARS-CoV-...

Background People living with HIV (PLHIV) have to take lifelong antiretroviral treatment, which is often challenging. Young people living with HIV (YPLHIV) have the lowest viral load suppression rates in Malawi and globally, mostly due to poor treatment adherence. This is a result of complex interactions of multiple factors unique to this demograph...

Introduction: Telemedicine is the provision of health services over a distance using information communication technology devices. Telemedicine is emerging as a promising component of healthcare care delivery worldwide, accelerated by the COVID-19 pandemic. This study assessed the factors promoting uptake, barriers, and opportunities for telemedic...

Objective: To describe the clinical features and assess the determinants of severity and in-hospital mortality of patients with coronavirus disease 2019 (COVID-19) from a unique setting in Ethiopia. Methods: Consecutive patients admitted to a COVID-19 isolation and treatment centre were included in this study. The overall clinical spectrum of COVID...

Background Adherence to antiretroviral (ARV) treatment for HIV infection is challenging because of many factors. The World Health Organization (WHO) has recommended using digital adherence technologies (DATs). However, there is limited evidence on how DATs improve adherence. Wisepill® is an internet-enabled medication dispenser found feasible and a...

Background: A well-functioning pharmaceutical supply system is an important aspect of ensuring efficient and proper clinical services in any health care system. This analysis was conducted on 31-member health facilities of the Christian Health Association Ghana (CHAG) to determine current consumption patterns and related expenditure for medicines o...

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6 . Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural an...

Children and adolescents living with HIV (CALHIV) form a significant proportion of people living with HIV (PLHIV). Optimal adherence (>95%) to medication is needed to achieve viral suppression. However, optimal adherence remains a challenge among CALHIV. Digital adherence tools (DAT) like the Wisepill® device have proven feasible among adult PLHIV....

Background Adherence to antiretroviral (ARV) treatment for HIV infection is challenging because of many factors. The World Health Organization (WHO) has recommended using digital adherence technologies (DATs). However, there is limited evidence on how DATs improve adherence. Wisepill® is an internet enable medication dispenser found feasible and ac...

Every year an estimated 5 to 8 million people die in low- and middle-income countries (LMICs) due to poor-quality care. Although quality improvements in healthcare facilities in LMICs are well-possible with tailored implementation plans, costs are often mentioned as a prohibiting factor. However, if quality improvements increase trust among patient...

Introduction In Africa almost half of healthcare services are delivered through private sector providers. These are often underused in national public health responses. To support and accelerate the public sector's COVID-19 response, we facilitated recruitment of additional private sector capacity by initiating a public-private partnership (PPP) in...

The COVID-19 pandemic has painfully exposed the constraints of fragile health systems in low- and middle-income countries, where global containment measures largely set by high-income countries resulted in disproportionate collateral damage. In Africa, a shift is urgently needed from emergency response to structural health systems strengthening eff...

Maternal and neonatal mortality rates in many low- and middle-income countries (LMICs) are still far above the targets of the United Nations Sustainable Development Goal 3. Value-based healthcare (VBHC) has the potential to outperform traditional supply-driven approaches in changing this dismal situation, and significantly improve maternal, neonata...

Introduction Inadequate, inefficient and slow processing of claims are major contributors to the cost of health insurance schemes, and therefore undermining their sustainability. This study uses the Technology, Organisation and Environment (TOE) framework to examine the preparedness of health facilities of the Christian Health Association of Ghana...

COVID-19 pandemic remains a major global public health challenge also in Low- and Middle-Income Countries (LMIC), due to fragile health systems, limited resources and personnel, low testing and counseling capacity, community perceptions, among others. In Kisumu County of Western Kenya, a unique Public Private Partnership (PPP) was rolled-out to inc...

Objective: In a multicountry prospective cohort of persons with HIV from six countries between 2007 and 2015, we evaluated long-term outcomes of first-line non-nucleoside reverse-transcriptase inhibitor-based antiretroviral therapy (ART), and risk factors for loss-to-follow-up, mortality, virological failure, and incomplete CD4+ T-cell recovery....

Test & Treat Project offers universal HIV testing and access to antiretroviral treatment in Northern Tanzania. The current cross-sectional study provides midterm results on HIV testing and counseling activities through community outreaches and facility-based services. A total 255,329 HIV tests were performed: 198,451 (77.7%) during testing campaign...

In low-and middle-income countries, achieving universal health coverage remains challenging due to insufficient, temporary and fragmented funding as well as limited accessibility to quality healthcare. Leveraging a mobile health platform can be a powerful tool to address these problems. This paper demonstrates how analysing data collected from a mo...

Background COVID-19 is overwhelming health systems universally. Increased capacity to combat the epidemic is important, while continuing regular healthcare services. This paper describes an innovative Public Private Partnership (PPP) against COVID-19 that from the onset of the epidemic was established in Kisumu County, Western Kenya. Methods An ex...

Background Serological testing for SARS-CoV-2 plays an important role for epidemiological studies, in aiding the diagnosis of COVID-19, and assess vaccine responses. Little is known on dynamics of SARS-CoV-2 serology in African settings. Here, we aimed to characterize the longitudinal antibody response profile to SARS-CoV-2 in Ethiopia. Methods In...

Background Differentiated service delivery (DSD) offers benefits to people living with HIV (improved access, peer support), and the health system (clinic decongestion, efficient service delivery). ART clubs, 15–30 clients who usually meet within the community, are one of the most common DSD options. However, evidence about the quality of care (QoC)...

Background HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR are driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remains unclear and African polic...

Background HIV testing is the first step to stop transmission. We aimed to evaluate HIV testing history and new diagnoses among adult outpatients in Kenya aged 18–39 years seeking care for symptoms of acute HIV infection (AHI). Methods The Tambua Mapema Plus study, a stepped-wedge trial, enrolled patients presenting to care at six primary care fac...

World Health Organization's recommendation to "treat all diagnosed with HIV" challenges the capacity of health systems, especially in low-and middle-resource countries. Current Tanzanian National Guidelines for the Management of HIV and AIDS views differentiated service delivery (DSD) models as promising approaches to improve HIV services. Nonethel...

Introduction: a subsidized community health insurance programme in Kwara State, Nigeria was temporarily suspended in 2016 in anticipation of the roll-out of a state-wide health insurance scheme. This article reports the adverse consequences of the scheme´s suspension on enrollees´ healthcare utilization. Methods: a mixed-methods study was carrie...

Background With antiretroviral therapy, more people living with HIV (PLHIV) in resource-limited settings are virally suppressed and living longer. WHO recommends differentiated service delivery (DSD) as an alternative, less resource-demanding way of expanding HIV services access. Monitoring client’s health-related quality of life (HRQoL) is necessa...

Objective This study examined people’s motivations for (repeatedly) utilizing HIV testing services during community-based testing events in urban and rural Shinyanga, Tanzania and potential implications for Universal Health Coverage (UHC). Methods As part of a broader multidisciplinary study on the implementation of a HIV Test and Treat model in S...

Background: Maternal and neonatal mortality rates in many low- and middle-income countries (LMICs) are still far above the targets of Sustainable Development Goal (SDG) 3. Value-based healthcare (VBHC) could potentially surpass traditional input-oriented approaches to create a high-quality health system and to improve maternal, newborn and child he...

Background Testing for SARS-CoV-2 in resource-poor settings remains a considerable challenge. Gold standard nucleic acid tests are expensive and depend on expensive equipment and highly trained laboratory staff. More affordable and easier real-time rapid tests are an attractive alternative. This study assessed field performance of such a test in we...

INTRODUCTION: SARS-CoV-2 testing is one of the options to combat COVID-19 in Kenya. In the first COVID-19 year there was limited tapping of the private sector's potential to scale up testing in Kenya. In April 2020, we initiated a unique public-private partnership (PPP) project in Kisumu County connecting the private sector to centralized testing s...

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a spectrum of clinical presentations. Evidence from Africa indicates that significantly less COVID-19 patients suffer from serious symptoms than in the industrialized world. We and others previously postulated a partial explanation for this phenomenon, bei...

Background Low- and middle-income countries (LMICs) are increasingly adopting low-cost Coronavirus disease 2019 (COVID-19) rapid antigen tests to meet the high demand for SARS-CoV-2 testing. Whilst testing using real-time polymerase chain reaction (RT-PCR) is the current gold standard, its widespread use in LMICs is limited by high costs, turnaroun...

The 2016–2017 Tanzania HIV Impact Survey (THIS) reported the accomplishments towards the 90-90-90 global HIV targets at 61-94-87, affirming the need to focus on the first 90 (i.e., getting 90% of people living with HIV (PLHIV) tested). We conducted a patient-pathway analysis to understand the gap observed, by assessing the alignment between where P...