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Ruhl LJ, Kiplagat J, O'Brien R, Wools-Kaloustian K, Scanlon M, Plater D, Thomas MR, Pastakia S, Gopal-Srivastava R, Morales-Soto N, Nyandiko W, Vreeman RC, Litzelman DK, Laktabai J. A Global Health Reciprocal Innovation grant programme: 5-year review with lessons learnt. BMJ Glob Health 2023; 8:e013585. [PMID: 37977589 PMCID: PMC10660845 DOI: 10.1136/bmjgh-2023-013585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Abstract
Unilateral approaches to global health innovations can be transformed into cocreative, uniquely collaborative relationships between low-income and middle-income countries (LMICs) and high-income countries (HIC), constituted as 'reciprocal innovation' (RI). Since 2018, the Indiana Clinical and Translational Sciences Institute (CTSI) and Indiana University (IU) Center for Global Health Equity have led a grants programme sculpted from the core elements of RI, a concept informed by a 30-year partnership started between IU (Indiana) and Moi University (Kenya), which leverages knowledge sharing, transformational learning and translational innovations to address shared health challenges. In this paper, we describe the evolution and implementation of an RI grants programme, as well as the challenges faced. We aim to share the successes of our RI engagement and encourage further funding opportunities to promote innovations grounded in the RI core elements. From the complex series of challenges encountered, three major lessons have been learnt: dedicating extensive time and resources to bring different settings together; establishing local linkages across investigators; and addressing longstanding inequities in global health research. We describe our efforts to address these challenges through educational materials and an online library of resources for RI projects. Using perspectives from RI investigators funded by this programme, we offer future directions resulting from our 5-year experience in applying this RI-focused approach. As the understanding and implementation of RI grow, global health investigators can share resources, knowledge and innovations that have the potential to significantly change the face of collaborative international research and address long-standing health inequities across diverse settings.
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Affiliation(s)
- Laura J Ruhl
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Rishika O'Brien
- Center for Global Health Equity, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Michael Scanlon
- AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Center for Global Health Equity, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David Plater
- AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Health Systems Design, Icahn School of Medicine at Mount Sinai Arnhold Institute for Global Health, New York, New York, USA
| | - Melissa R Thomas
- Center for Health Services Research, Regenstrief Institute Inc, Indianapolis, Indiana, USA
| | - Sonak Pastakia
- AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Center for Health Equity and Innovation, Purdue University College of Pharmacy Nursing and Health Sciences, West Lafayette, Indiana, USA
| | - Rashmi Gopal-Srivastava
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Nydia Morales-Soto
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, USA
| | - Winstone Nyandiko
- AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Rachel C Vreeman
- AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Health Systems Design, Icahn School of Medicine at Mount Sinai Arnhold Institute for Global Health, New York, New York, USA
| | - Debra K Litzelman
- Center for Global Health Equity, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute Inc, Indianapolis, Indiana, USA
| | - Jeremiah Laktabai
- AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya
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Chang AY, Karwa R, Odhiambo H, Were P, Fletcher SL, Tonui EC, Kohn MA, Lee J, Chang D, Lensing S, Namaemba DF, Busakhala N, Kiprono SK, Maurer T, Goodrich S, Pastakia SD. Compression Therapy for HIV-Associated Kaposi Sarcoma Leg Lymphedema: Results of the Kenyan Improvised Compression for Kaposi Sarcoma Randomized Controlled Trial. JCO Glob Oncol 2022; 8:e2100329. [PMID: 35025687 PMCID: PMC8769101 DOI: 10.1200/go.21.00329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/19/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Evaluate the effectiveness of compression while receiving chemotherapy compared with chemotherapy alone in the treatment of HIV-associated Kaposi sarcoma (KS) lymphedema. METHODS A randomized controlled trial was conducted in a single oncology clinic in western Kenya (NCT03404297). A computer-generated randomization schedule was used to allocate treatment arms. Randomized block design was used for stratification by lymphedema stage. Participants were HIV positive adults age ≥ 18 years on antiretroviral therapy with biopsy-proven KS associated with leg lymphedema and being initiated on chemotherapy. The intervention was 10 weeks of weekly clinic-based application of two-component paste compression bandages. The primary outcome was change in the Lower Extremity Lymphedema Index (LELI) score from week 0 to week 14. The secondary outcomes were change in the Lymphedema Quality of Life measure (LYMQOL) and change in the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 score from week 0 to week 14. Blinded outcome assessments were conducted. RESULTS Of 30 participants randomly assigned, 25 eligible patients (chemotherapy [control], n = 13; compression plus chemotherapy [intervention], n = 12) returned at week 14. Change in LELI, LYMQOL, and EORTC QLQ-C30 scores between week 14 and week 0 did not significantly differ by arm. The mean (standard deviation) change in LELI score was -25.9 (34.6) for the control arm compared with -13.3 (29.5) for the intervention arm, P = .340. The difference (95% CI) in the change in LELI score was -12.6 (-39.3 to 14.1). CONCLUSION Future studies evaluating a 14-week change in LELI for KS lymphedema should assume a standard deviation of approximately 30. Lessons learned from this pilot trial should inform the development of a larger, multicenter trial to evaluate the effectiveness of compression for KS lymphedema.
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Affiliation(s)
- Aileen Y Chang
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Dermatology, San Francisco, CA
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | - Rakhi Karwa
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Purdue University School of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, Indianapolis, IN
- Moi University School of Medicine, Department of Pharmacology, Eldoret, Kenya
| | - Haji Odhiambo
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | - Phelix Were
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | | | - Edith C Tonui
- Kericho County Referral Hospital, Pharmacy Department, Kericho, Kenya
| | - Michael A Kohn
- University of California, San Francisco School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, CA
| | - Jeannette Lee
- University of Arkansas for Medical Sciences, Department of Biostatistics, Little Rock, AR
| | - Di Chang
- University of Arkansas for Medical Sciences, Department of Biostatistics, Little Rock, AR
| | - Shelly Lensing
- University of Arkansas for Medical Sciences, Department of Biostatistics, Little Rock, AR
| | | | - Naftali Busakhala
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Moi University School of Medicine, Department of Pharmacology, Eldoret, Kenya
| | - Samson K Kiprono
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Moi University School of Medicine, Department of Medicine, Eldoret, Kenya
| | - Toby Maurer
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Indiana University School of Medicine, Department of Dermatology, Indianapolis, IN
| | - Suzanne Goodrich
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Indiana University School of Medicine, Department of Medicine, Division of Infectious Diseases, Indianapolis, IN
| | - Sonak D Pastakia
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Purdue University School of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, Indianapolis, IN
- Moi University School of Medicine, Department of Pharmacology, Eldoret, Kenya
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Chang AY, Mungai M, Coates SJ, Chao T, Odhiambo HP, Were PM, Fletcher SL, Maurer T, Karwa R, Pastakia SD. Implementing a Locally Made Low-Cost Intervention for Wound and Lymphedema Care in Western Kenya. Dermatol Clin 2021; 39:91-100. [PMID: 33228865 PMCID: PMC7686544 DOI: 10.1016/j.det.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In Western Kenya, the burden of chronic wounds and lymphedema has a significant impact on functionality and quality of life. Major barriers to provision of care include availability, affordability, and accessibility of bandages. At the Academic Model Providing Access to Healthcare, dermatologists and pharmacists collaborated to develop a 2-component compression bandage modeled after the Unna boot, using locally available materials, that is distributed through a revolving fund pharmacy network. In partnership with nursing, use of these bandages at a national referral hospital and a few county facilities has increased, but increasing utilization to an expanded catchment area is needed.
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Affiliation(s)
- Aileen Y Chang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Dermatology, University of California, School of Medicine, P.O. Box 4606 Eldoret, Kenya 30100.
| | - Margaret Mungai
- Clinical Services, Moi Teaching & Referral Hospital, PO Box 3, Code 30100, Eldoret, Kenya
| | - Sarah J Coates
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Dermatology, University of California, San Francisco School of Medicine, 1701 Divisadero Street, Suite 4-20, San Francisco, CA 94143-0316, USA
| | - Tiffany Chao
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA 92617, USA
| | | | - Phelix M Were
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sara L Fletcher
- Drug Use Research and Management, Oregon State University College of Pharmacy, 2730 SW Moody Avenue, CL5CP, Portland, OR 97201, USA
| | - Toby Maurer
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 139, Indianapolis, IN 46202, USA
| | - Rakhi Karwa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN 46202-2879, USA
| | - Sonak D Pastakia
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN 46202-2879, USA
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Karwa R, Miller ML, Schellhase E, Tran D, Manji I, Njuguna B, Fletcher S, Kanyi J, Maina M, Jakait B, Kigen G, Kipyegon V, Aruasa W, Crowe S, Pastakia SD. Evaluating the impact of a 15‐year academic partnership to promote sustainable engagement, education, and scholarship in global health. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Rakhi Karwa
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Monica L. Miller
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Ellen Schellhase
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Dan Tran
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Imran Manji
- Moi Teaching and Referral Hospital Eldoret Kenya
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | | | - Sara Fletcher
- Department of Drug Use Research and Management, Oregon State University College of Pharmacy Corvallis Oregon USA
| | - John Kanyi
- Moi Teaching and Referral Hospital Eldoret Kenya
| | - Mercy Maina
- Moi Teaching and Referral Hospital Eldoret Kenya
| | | | - Gabriel Kigen
- Department of Pharmacology & Therapeutics, Moi University College of Health Sciences Eldoret Kenya
| | | | - Wilson Aruasa
- Moi Teaching and Referral Hospital Eldoret Kenya
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Susie Crowe
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy East Tennessee State University Johnson Tennessee USA
| | - Sonak D. Pastakia
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
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Mutebi M, Scroggins D, Simmons V, Oti NO, Hammad N. Engaging Patients for Clinical Trials in Africa: Patient-Centered Approaches. JCO Glob Oncol 2020; 6:942-947. [PMID: 32614725 PMCID: PMC7392709 DOI: 10.1200/jgo.19.00190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Clinical trials in oncology are an emergent field in sub-Saharan Africa. There is a long history of clinical trials in high-income countries (HICs), with increasing attempts to develop patient-centric approaches and to evaluate patient-centered outcomes. The challenge remains as to how these trends could be adopted in low-resource settings and adapted to best fit the different health ecosystems that coexist on the African continent. Models that evaluate patient-related outcomes and measures and that are used in HICs must be modified, adopted, and adapted to suit the diverse populations and the low-resource settings in most of the continent. Patient engagement in clinical trials in Africa must be well nuanced, and it demands innovation and application of models that consider established but tailored notions/principles of patient and community engagement and the unique sociocultural aspects of different populations. It also must be linked to strategies that aim to improve patient education, health literacy, and access to services and to encourage and protect patient autonomy.
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Affiliation(s)
| | | | | | | | - Nazik Hammad
- Queen's University Cancer Center of Southeastern Ontario, Kingston Health Science Center, Kingston, Ontario, Canada
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