Changing the COVID-19 Narrative in Africa: Using an Implementation Research Lens to Understand Successes and Plan for Challenges Ahead.

Despite predictions that the number of deaths in Africa due to COVID-19 will reach 10 million, overall, the continent has reported relatively few cases compared to the rest of the world. Many African countries have been successful in containing initial outbreaks by rapidly using evidence-based interventions through implementation strategies adapted from other countries' COVID-19 response as well as from prior epidemics. However, it is unclear whether these interventions will lead to long-term and complete success in stopping COVID-19 spread. Implementation research is a tool that can be used by countries to learn how to identify and understand contextual factors impacting COVID-19 prevention and control and select evidence-based interventions and strategies known to reduce spread of the virus. We identify seven key contextual factors that are facilitators or barriers to implementation of these interventions, and several strategies that can be leveraged if the factor is present or ones to strengthen if weak to improve implementation. These factors are: a culture of accountability, national coordination, financial stability of the population, culture of innovation, culture and capacity for research, health systems strength, and cross-border economies. Implementation science methods can serve to develop knowledge at a country and regional level on how to identify, utilize, and address these and other contextual factors, and inform relevant evidence-based interventions and implementation strategies. This approach can support African countries' ability to address key challenges as they arise, both in fighting COVID-19 and future health systems challenges.