Introduction In the 1970s, very few international programmes provided support to strengthen tropical disease research capacity and most research for the diseases prevalent in low- and middle-income ...countries (LMICs) was done by scientists and institutions in advanced industrialised countries. ...at different times in TDR's history there have been competitive grants exclusively targeting low-income countries to help them increase their capacities.
Adverse Drug Reactions (ADRs) are a major clinical and public health problem world-wide. The prompt reporting of suspected ADRs to regulatory authorities to activate drug safety surveillance and ...regulation appears to be the most pragmatic measure for addressing the problem. This paper evaluated a pharmacovigilance (PV) training model that was designed to improve the reporting of ADRs in public health programs treating the Human Immunodeficiency Virus (HIV), Tuberculosis (TB) and Malaria.
A Structured Pharmacovigilance and Training Initiative (SPHAR-TI) model based on the World Health Organization accredited Structured Operational Research and Training Initiative (SOR-IT) model was designed and implemented over a period of 12 months. A prospective cohort design was deployed to evaluate the outcomes of the model. The primary outcomes were knowledge gained and Individual Case Safety Reports (ICSR) (completed adverse drug reactions monitoring forms) submitted, while the secondary outcomes were facility based Pharmacovigilance Committees activated and health facility healthcare workers trained by the participants.
Fifty-five (98%) participants were trained and followed up for 12 months. More than three quarter of the participants have never received training on pharmacovigilance prior to the course. Yet, a significant gain in knowledge was observed after the participants completed a comprehensive training for six days. In only seven months, 3000 ICSRs (with 100% completeness) were submitted, 2,937 facility based healthcare workers trained and 46 Pharmacovigilance Committees activated by the participants. Overall, a 273% increase in ICSRs submission to the National Agency for Food and Drug Administration and Control (NAFDAC) was observed.
Participants gained knowledge, which tended to increase the reporting of ADRs. The SPHAR-TI model could be an option for strengthening the continuous reporting of ADRs in public health programs in resource limited settings.
BackgroundThe EDCTP SAVING Consortium aimed to build Institutional and individual capacity in Implementation Research (IR). This was to enable Stakeholder Institutions along the Access and Delivery ...value chain identify and address implementation bottlenecks hindering delivery of new medical interventions such as vaccine. As a first step in the capacity building, there was a need to tailor the Massive Open Online Course on IR to the availability needs of the target institutions. MethodsInitial consultations were held with trainees to agree on the mode of training that would be most impactful. Extensive consultations were held with local organizers of the MOOC to discuss adapting the mode of training to suit the Consortium. A variety of approaches were considered based on earlier experience with other institutions. The MOOC was held weekly over a 5-week period with 3 to 4 hours at each sitting. This was alternated with a free week to enable members see to their other duties at their institutions. Two modules were taken at each sitting. During each training session, members watched the videos together with onsite facilitators who were Senior Investigators in the Consortium and who were IR trainers. Each video was followed by an interactive session during which facilitators clarified any unclear areas providing practical examples. Trainees took the assessments immediately. Outstanding assessments were completed before the next in-person session. All 5 models were completed in three sessions over a 5-week period. ResultsBy the end of the 5-week period, out of the total of 53 participants who enrolled, 41 successfully completed the MOOC and gained TDR certificates of completion by the end of the period. ConclusionThis model for undertaking the MOOC is a good choice for participants who require IR training but who have very busy work schedules like participants in our setting.
BackgroundA key objective of the EDCTP SAVING Consortium was to build Institutional and Individual capacity in Implementation Research (IR). The aim was to equip institutions along the Access and ...Delivery Value Chain to identify and address bottlenecks hindering delivery of new medical interventions including vaccines using IR. MethodsA Capacity Needs Assessment was carried out and results used to plan the capacity building approach. All trainees were enrolled and undertook a specialized Massive Open Online Course (MOOC) on IR. The MOOC was adapted to suit availability needs of trainees. Trainees were then taken through three in-person 5-day residential IR workshops. The workshops covered proposal development, preparation of documentation for ethical approval, and Report/manuscript writing. The workshops involved presentations by experienced facilitator/investigators within the consortium with supportive sessions where trainees put into practice what they had learnt. Each workshop was interspersed with a period of six weeks during which the trainees completed the required outputs. A unique feature adapted from an earlier TDR funded study included embedding of Research Scientists in each of the teams to provide on-going support during and in between workshops. Senior Consortium Investigators provided back-up support. ResultsThe needs assessment showed that 64.1% of 78 respondents considered themselves beginners with regards to experience in IR. By the end of workshop 1, four proposals addressing bottlenecks identified had been successfully drafted by three teams from stakeholder institutions. After workshop 2, three proposals were submitted for ethical review and approvals obtained. All three teams are currently at various stages of data collection and analysis. ConclusionThis hands-on model for Institutional training in IR is effective as it ensures that trainees obtain needed support as their capacity is being built. They “learn by in doing” in real time, while capacity and confidence is built in a sustained manner.
Adverse drug reactions (ADRs) contribute to ill-health or life-threatening outcomes of therapy during management of infectious diseases. The exposure to anti-malarial and use of mobile phone ...technology to report ADRs following drug exposures were investigated in Sagamu--a peri-urban community in Southwest Nigeria.
Purchase of medicines was actively monitored for 28 days in three Community Pharmacies (CP) and four Patent and Proprietary Medicine Stores (PPMS) in the community. Information on experience of ADRs was obtained by telephone from 100 volunteers who purchased anti-malarials during the 28-day period.
A total of 12,093 purchases were recorded during the period. Antibiotics, analgesics, vitamins and anti-malarials were the most frequently purchased medicines. A total of 1,500 complete courses of anti-malarials were purchased (12.4% of total purchases); of this number, purchases of sulphadoxine-pyrimethamine (SP) and chloroquine (CQ) were highest (39.3 and 25.2% respectively). Other anti-malarials purchased were artesunate monotherapy (AS)--16.1%, artemether-lumefantrine (AL) 10.0%, amodiaquine (AQ)--6.6%, quinine (QNN)--1.9%, halofantrine (HF)--0.2% and proguanil (PR)--0.2%. CQ was the cheapest (USD 0.3) and halofantrine the most expensive (USD 7.7). AL was 15.6 times ($4.68) more expensive than CQ. The response to mobile phone monitoring of ADRs was 57% in the first 24 hours (day 1) after purchase and decreased to 33% by day 4. Participants in this monitoring exercise were mostly with low level of education (54%).
The findings from this study indicate that ineffective anti-malaria medicines including monotherapies remain widely available and are frequently purchased in the study area. Cost may be a factor in the continued use of ineffective monotherapies. Availability of a toll-free telephone line may facilitate pharmacovigilance and follow up of response to medicines in a resource-poor setting.
About the Authors: Alison Krentel * E-mail: akrentel@bruyere.org Affiliation: Bruyère Research Institute, Ottawa, Canada ORCID logo http://orcid.org/0000-0001-7213-1577 Margaret Gyapong Affiliation: ...Centre for Health Policy and Implementation Research, Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana Olumide Ogundahunsi Affiliation: Research Capacity Strengthening, Special Programme for Research and Training in Tropical Diseases, WHO Geneva, Switzerland Mary Amuyunzu-Nyamongo Affiliation: African Institute for Health and Development, Nairobi, Kenya Deborah A. McFarland Affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America ORCID logo http://orcid.org/0000-0002-0019-5165 Citation: Krentel A, Gyapong M, Ogundahunsi O, Amuyunzu-Nyamongo M, McFarland DA (2018) Ensuring no one is left behind: The authors have declared that no competing interests exist. Since the ambitious goals to eliminate and control neglected tropical diseases (NTDs) were launched, the crucial role of partnerships has been emphasized as a pathway to ensure success. ...we should not shy away from the time and financial commitment that is needed to properly address these implementation questions. ...as we dedicated ourselves to ensuring that no one is left behind in the Geneva commitment signed at the end of the NTD summit a year ago in April 2017 13, let us mobilize our efforts to understand why some people, communities, and ethnic groups are left behind.
Prescription practices have been shown to influence the emergence of anti-malarial drug resistance. Thus efforts in this study were devoted to evaluating the prescribing practices prior to ...introduction of the artemisinin based combination therapy (ACT) in Nigeria and its potential contribution to emergence of chloroquine resistant malaria in south-west Nigeria, in order to forestall a similar situation with the ACT.
A retrospective quantitative study was designed to examine case records of patients treated for malaria in either a government or a private hospital in Ibadan, south-west Nigeria, over a 20-year period, cutting across three phases of resistance to chloroquine in Nigeria: pre-resistance, emerging resistance and dissemination of resistance. Patient prescriptions were examined for use of anti-malarial drugs, sub-therapeutic doses of chloroquine, co-administration of anti-histamines with chloroquine. Descriptive statistics of frequency and percentage were used to describe trends in the parameters assessed using EPI-info.
Case record files of 2,529 patients were examined. Chloroquine was the main drug used in treatment of malaria throughout the periods studied, with frequency of prescription at both sites ranging from 91.4% to 98.3% during the pre-resistance years. It was administered as standard doses during the pre resistance years. Anti-histamines, especially promethazine, were routinely co-administered with chloroquine at this period too. However, the practice of prescribing sub-therapeutic doses of chloroquine at the private health care facility coincided with the latter phase of emerging resistance and phase of dissemination of resistance. Frequency of prescription of sub-therapeutic doses increased from 6.7% in 1983 (pre-resistance years) to 43.6% in 1997 (dissemination of resistance phase) at the private health care facility. Frequency of co-administration of anti-histamines with chloroquine also reduced during the period of dissemination of resistance.
The results from this study describe a lack of adherence to national treatment guidelines, especially in the private sector, and a relationship between prescription practices and dissemination of drug resistant falciparum malaria. As Nigeria adopts the use of ACT, there is an urgent need to improve malaria treatment practices in Nigeria in order to prolong the clinical shelf-life of the combination.
Measuring the impact of capacity strengthening support is a priority for the international development community. Several frameworks exist for monitoring and evaluating funding results and ...modalities. Based on its long history of support, we report on the impact of individual and institutional capacity strengthening programmes conducted by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and on the factors that influenced the outcome of its Research Capacity Strengthening (RCS) activities.
A mix of qualitative and quantitative methods (questionnaires and in-depth interviews) was applied to a selected group of 128 individual and 20 institutional capacity development grant recipients that completed their training/projects between 2000 and 2008. A semi-structured interview was also conducted on site with scientists from four institutions. Most of the grantees, both individual and institutional, reported beneficial results from the grant. However, glaring inequities stemming from gender imbalances and a language bias towards English were identified. The study showed that skills improvement through training contributed to better formulation of research proposals, but not necessarily to improved project implementation or communication of results. Appreciation of the institutional grants' impact varied among recipient countries. The least developed countries saw the programmes as essential for supporting basic infrastructure and activities. Advanced developing countries perceived the research grants as complementary to available resources, and particularly suitable for junior researchers who were not yet able to compete for major international grants.
The study highlights the need for a more equitable process to improve the effectiveness of health research capacity strengthening activities. Support should be tailored to the existing research capacity in disease endemic countries and should focus on strengthening national health research systems, particularly in the least developing countries. The engagement of stakeholders at country level would facilitate the design of more specific and comprehensive strategies based on local needs.
Digital technologies are playing an increasing role in the global response to tuberculosis (TB), however their effectiveness and impact are often shaped in the context in which they are implemented. ...Implementation research can help facilitate the effective introduction of digital health technologies in TB programmes. In 2020, the Implementation Research for Digital Technologies and TB online toolkit (IR4DTB) was developed and launched by the Special Programme for Research and Training in Tropical Diseases, and the Global TB Programme at the World Health Organization (WHO), to build local capacity for IR and promote the effective use of digital technologies within TB programmes. This paper describes the development and piloting of the IR4DTB toolkit, a self-learning tool designed for TB programme implementers. The toolkit comprises six modules reflecting key steps of the IR process, practical instructions and guidance on how to complete these steps, and real-word case studies to illustrate key learning points. This paper also describes the launch of the IR4DTB during a five-day training workshop with TB staff from China, Uzbekistan, Pakistan, Malaysia. The workshop included facilitated sessions on the IR4DTB modules, and provided an opportunity for participants to work with facilitators to develop a comprehensive IR proposal addressing an identified challenge related to the implementation and/or scale-up of digital health technologies for TB care in their home country. Post-workshop evaluation revealed high level of satisfaction among participants with the workshop content and format. The IR4DTB toolkit is a replicable model which can be used to strengthen the TB staff capacity to innovate within a culture of continuous collection of evidence. Through continued trainings and adaptation of the toolkit alongside the integration of digital technologies within TB prevention and care, this model has the potential to contribute directly to all components of the End TB Strategy.
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