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Amboka P, Kurui D, Wamukoya M, Sindi JK, Vicente-Crespo M. A landscape analysis of clinical trials and infant clinical trials in Kenya, Ethiopia, and Nigeria. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1417419. [PMID: 39211394 PMCID: PMC11357950 DOI: 10.3389/fepid.2024.1417419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024]
Abstract
Introduction Global inequality in clinical research capacity and service delivery can be indicated simply by the proportion of clinical trials that a country or region has registered in clinical trial registry databases. The proportion of clinical trials registered in Africa is very low at 0.02%, even though the region accounts for approximately 15% of the world's population. Despite the economic challenges in most African countries, they have shown potential for growth and change in recent years. Methods We conducted desk reviews on the interventional clinical trials done in Kenya, Ethiopia, and Nigeria between 2015 to May 2023. The search was done in clinical trials repositories, and journal repositories. The search focused on intervention clinical trials. Data was extracted by screening through the publications and clinical trial platforms. The data extracted from the publications included the type of clinical trial, clinical trial phase, diseases, etc. The data extracted from the reports included: challenges in conducting clinical trials, capacity-building efforts, and the impact of the clinical trial. Results The number of clinical trial studies identified in Kenya was 113 (28 were on infant clinical trials). The study identified 97 clinical trials in Nigeria, of which 11 studies were on infant clinical trials. In Ethiopia, there were 28 clinical trials and only five were on infant clinical trials. The landscape review also expanded to capacity and gaps in clinical trials in the three countries. The largest proportion of clinical trials carried out in Kenya was on injury, occupational disease, and poisoning, 30.5% (n = 18) and the smallest proportion was on kidney disease, neonatal disease, obstetrics, and gynecology. Most Infant clinical trials were carried out in the area of infections and infestations 33.3% (n = 7). Most of the challenges faced by clinical trials in the three countries include a lack of infrastructure, a lack of human resources, and a lack of financial resources. Implications There is a need to map clinical trials done by African researchers based in Africa to exclude the trials done by non-African researchers based in Africa. Opportunities for clinical trials should be supported and challenges addressed.
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Affiliation(s)
- Patrick Amboka
- Research and Related Capacity Strengthening Division, African Population and Health Research Center, APHRC, Nairobi, Kenya
| | - Daniel Kurui
- Research and Related Capacity Strengthening Division, African Population and Health Research Center, APHRC, Nairobi, Kenya
| | - Marylene Wamukoya
- Research and Related Capacity Strengthening Division, African Population and Health Research Center, APHRC, Nairobi, Kenya
| | - Julius Kirimi Sindi
- Research and Related Capacity Strengthening Division, African Population and Health Research Center, APHRC, Nairobi, Kenya
| | - Marta Vicente-Crespo
- Research and Related Capacity Strengthening Division, African Population and Health Research Center, APHRC, Nairobi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Kizub D, Manner CK, Graef K, Abubakar B, Orem J, Odedina F, Adeyeye MC, Nakigudde G, Ayalew K, Kalidas C, Lyerly HK, Norman T, Fashoyin-Aje L, Freedman J, Dent J, Cance B, Gralow J. Action for Increasing Diversity, Market Access, and Capacity in Oncology Registration Trials—Is Africa the Answer? Report From a Satellite Session of the Accelerating Anti-Cancer Agent Development and Validation Workshop. JCO Glob Oncol 2022; 8:e2200117. [PMID: 35714309 PMCID: PMC9232363 DOI: 10.1200/go.22.00117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients of African ancestry are not well-represented in cancer clinical trials despite bearing a disproportionate share of mortality both in United States and Africa. We describe key stakeholder perspectives and priorities related to bringing early-stage cancer clinical trials to Africa and outline essential action steps. Increasing Diversity, Market Access, and Capacity in Oncology Registration Trials—Is Africa the Answer? satellite session was organized at 2021 Accelerating Anti-Cancer Agent Development and Validation Workshop. Panelists included representatives of African Organization for Research and Training in Cancer, Uganda Cancer Institute, Uganda Women's Cancer Support Organization, BIO Ventures for Global Health, Bill & Melinda Gates Foundation, the US Food and Drug Administration, Nigeria's National Agency for Food and Drug Administration and Control, Bayer, and Genentech, with moderators from ASCO and American Cancer Society. Key discussion themes and resulting action steps were agreed upon by all participants. Panelists agreed that increasing diversity in cancer clinical trials by including African patients is key to ensuring novel drugs are safe and effective across populations. They underscored the importance of equity in clinical trial access for patients in Africa. Panelists discussed their values related to access and barriers to opening clinical trials in Africa and described innovative solutions from their work aimed at overcoming these obstacles. Multisectoral collaboration efforts that allow leveraging of limited resources and result in sustainable capacity building and mutually beneficial long-term partnerships were discussed as key to outlined action steps. The panel discussion resulted in valuable insights about key stakeholder values and priorities related to bringing early-stage clinical trials to Africa, as well as specific actions for each stakeholder group.
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Affiliation(s)
- Darya Kizub
- University of Texas MD Anderson Research Center, Houston, TX
| | | | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA
| | - Bello Abubakar
- National Hospital, Abuja, Nigeria
- African Organization for Research and Training in Cancer (AORTIC), Rondebosch, South Africa
| | | | - Folakemi Odedina
- African Organization for Research and Training in Cancer (AORTIC), Rondebosch, South Africa
- Mayo Clinic, Rochester, MN
| | | | | | - Kassa Ayalew
- United States Food and Drug Administration, Silver Spring, MD
| | | | | | - Thea Norman
- Bill & Melinda Gates Foundation, Seattle, WA
| | | | | | | | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA
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Alemayehu C, Nikles J, Mitchell G. N-of-1 trials in the clinical care of patients in developing countries: a systematic review. Trials 2018; 19:246. [PMID: 29685163 PMCID: PMC5914018 DOI: 10.1186/s13063-018-2596-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/16/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND N-of-1 trials have a potential role in promoting patient-centered medicine in developing countries. However, there is limited academic literature regarding the use of N-of-1 trials in the clinical care of patients in resource-poor settings. OBJECTIVE To assess the extent of use, purpose and treatment outcome of N-of-1 trials in developing countries. METHOD A systematic review of clinical N-of-1 trials was conducted between 1985 and September 2015 using PubMed, Embase, CINAHL, Web of Science and the Cochrane Central Register of Controlled Trials. Grey literature databases and clinical trial registers were also searched. This review included randomized, multi-cycle, crossover within individual patient trials involving drug intervention. Quality assessment and data extraction were conducted by two independent reviewers. RESULT Out of 131 N-of-1 trials identified, only 6 (4.5%) were conducted in developing countries. The major reason that N-of-1 trials were used was to provide evidence on feasibility, effectiveness and safety of therapies. A total of 72 participants were involved in these trials. Five of the studies were conducted in China and all evaluated Chinese traditional medicine. The remaining study was conducted in Brazil. The completion rate was 93%. More than half, 46 (69%) of subjects made medication changes consistent with trial results after trial completion. A number of threats to the validity of the included evidence limited the validity of the evidence. In particular, the estimated overall effect in four of the included studies could have been affected by the "carry over" of the previous treatment effect as no adequate pharmacokinetic evidence regarding traditional medicines was presented. CONCLUSION The prevalence and scope of N-of-1 trials in developing countries is low. A coordinated effort among government, clinicians, researchers and sponsor organizations is needed to increase their uptake and quality in developing countries. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015026841 .
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Fekadu A, Hailu A, Makonnen E, Belete A, Yimer G. Short-term impact of celebrating the international clinical trial day: experience from Ethiopia. Trials 2017; 18:332. [PMID: 28716101 PMCID: PMC5513083 DOI: 10.1186/s13063-017-2081-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 07/01/2017] [Indexed: 11/29/2022] Open
Abstract
Just over 2 years ago on 20 May 2014, we celebrated the first International Clinical Trial Day (ICTD) in Ethiopia at the College of Health Sciences, Addis Ababa University. The main aim of the celebration was to express solidarity with clinical researchers, particularly clinical trialists, across the world. Since this first celebration, several major steps have been taken with potential for improving the conduct of clinical trials in our institution and more broadly within the country. These have included policy impact, particularly commitment from the government and the institution for supporting clinical trials and for the broader improvement of access to medicines. A Clinical Trial Unit, led by a multi-disciplinary team of researchers, has been established. A regional centre of excellence is being established to build regional capacity for translational research and clinical trials. These are important outputs attributable to the celebration of the ICTD. We encourage ICTD celebration at institutions conducting clinical research. This is likely to have unanticipated positive institutional, national and even regional consequences.
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Affiliation(s)
- Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia. .,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. .,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK.
| | - Asrat Hailu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.,Department of Microbiology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.,Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anteneh Belete
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.,Department of Pharmaceutics, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.,Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Gutierrez MM, Pillai G, Felix S, Romero F, Onyango KO, Owusu-Agyei S, Asante KP, Barnes KI, Sinxadi P, Allen E, Abdulla S, Masimirembwa C, Munyoro M, Yimer G, Gebre-Mariam T, Spector J, Ogutu B. Building Capability for Clinical Pharmacology Research in Sub-Saharan Africa. Clin Pharmacol Ther 2017; 102:786-795. [PMID: 28378903 DOI: 10.1002/cpt.695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/28/2017] [Accepted: 03/22/2017] [Indexed: 01/13/2023]
Abstract
A strong scientific rationale exists for conducting clinical pharmacology studies in target populations because local factors such as genetics, environment, comorbidities, and diet can affect variability in drug responses. However, clinical pharmacology studies are not widely conducted in sub-Saharan Africa, in part due to limitations in technical expertise and infrastructure. Since 2012, a novel public-private partnership model involving research institutions and a pharmaceutical company has been applied to developing increased capability for clinical pharmacology research in multiple African countries.
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Affiliation(s)
- M M Gutierrez
- Novartis Pharma and Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, Massachusetts, USA
| | - G Pillai
- Novartis Pharma and Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, Massachusetts, USA
| | - S Felix
- Novartis Pharma and Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, Massachusetts, USA
| | - F Romero
- Novartis Pharma and Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, Massachusetts, USA
| | - K O Onyango
- Kenya Medical Research Institute (KEMRI)/Strathmore University (SU), Nairobi, Kenya
| | | | - K P Asante
- Kintampo Health Research Center, Kintampo, Ghana
| | - K I Barnes
- University of Cape Town, Cape Town, South Africa
| | - P Sinxadi
- University of Cape Town, Cape Town, South Africa
| | - E Allen
- University of Cape Town, Cape Town, South Africa
| | - S Abdulla
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - C Masimirembwa
- African Institute of Biomedical Science & Technology, Harare, Zimbabwe
| | - M Munyoro
- African Institute of Biomedical Science & Technology, Harare, Zimbabwe
| | - G Yimer
- Addis Ababa University/Regional Bioequivalence Center, Addis Ababa, Ethiopia
| | - T Gebre-Mariam
- Addis Ababa University/Regional Bioequivalence Center, Addis Ababa, Ethiopia
| | - J Spector
- Novartis Pharma and Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, Massachusetts, USA
| | - B Ogutu
- Kenya Medical Research Institute (KEMRI)/Strathmore University (SU), Nairobi, Kenya
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Vischer N, Pfeiffer C, Limacher M, Burri C. "You can save time if…"-A qualitative study on internal factors slowing down clinical trials in Sub-Saharan Africa. PLoS One 2017; 12:e0173796. [PMID: 28301530 PMCID: PMC5354381 DOI: 10.1371/journal.pone.0173796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 02/27/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The costs, complexity, legal requirements and number of amendments associated with clinical trials are rising constantly, which negatively affects the efficient conduct of trials. In Sub-Saharan Africa, this situation is exacerbated by capacity and funding limitations, which further increase the workload of clinical trialists. At the same time, trials are critically important for improving public health in these settings. The aim of this study was to identify the internal factors that slow down clinical trials in Sub-Saharan Africa. Here, factors are limited to those that exclusively relate to clinical trial teams and sponsors. These factors may be influenced independently of external conditions and may significantly increase trial efficiency if addressed by the respective teams. METHODS We conducted sixty key informant interviews with clinical trial staff working in different positions in two clinical research centres in Kenya, Ghana, Burkina Faso and Senegal. The study covered English- and French-speaking, and Eastern and Western parts of Sub-Saharan Africa. We performed thematic analysis of the interview transcripts. RESULTS We found various internal factors associated with slowing down clinical trials; these were summarised into two broad themes, "planning" and "site organisation". These themes were consistently mentioned across positions and countries. "Planning" factors related to budget feasibility, clear project ideas, realistic deadlines, understanding of trial processes, adaptation to the local context and involvement of site staff in planning. "Site organisation" factors covered staff turnover, employment conditions, career paths, workload, delegation and management. CONCLUSIONS We found that internal factors slowing down clinical trials are of high importance to trial staff. Our data suggest that adequate and coherent planning, careful assessment of the setting, clear task allocation and management capacity strengthening may help to overcome the identified internal factors and allow clinical trials to proceed more efficiently.
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Affiliation(s)
- Nerina Vischer
- Swiss Tropical and Public Health Institute, Department of Medicines Research, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Constanze Pfeiffer
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Basel, Switzerland
| | - Manuela Limacher
- Swiss Tropical and Public Health Institute, Department of Medicines Research, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Burri
- Swiss Tropical and Public Health Institute, Department of Medicines Research, Basel, Switzerland
- University of Basel, Basel, Switzerland
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7
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Vischer N, Pfeiffer C, Joller A, Klingmann I, Ka A, Kpormegbe SK, Burri C. The Good Clinical Practice guideline and its interpretation - perceptions of clinical trial teams in sub-Saharan Africa. Trop Med Int Health 2016; 21:1040-1048. [PMID: 27260671 DOI: 10.1111/tmi.12734] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore the advantages and challenges of working with the Good Clinical Practice (GCP)-International Conference of Harmonization (ICH) E6 guideline and its interpretation from the perspective of clinical trial teams based in sub-Saharan Africa. METHODS We conducted 60 key informant interviews with clinical trial staff at different levels in clinical research centres in Kenya, Ghana, Burkina Faso and Senegal and thematically analysed the responses. RESULTS Clinical trial teams perceived working with ICH-GCP as highly advantageous and regarded ICH-GCP as applicable to their setting and efficiently applied. Only for informed consent did some clinical trial staff (one-third) perceive the guideline as insufficiently applicable. Specific challenges included meeting the requirements for written and individual consent, conditions for impartial witnesses for illiterates or legally acceptable representatives for children, guaranteeing voluntary participation and ensuring full understanding of the consent given. It was deemed important to have ICH-GCP compliance monitored by relevant ethics committees and regulatory authorities, without having guidelines applied overcautiously. CONCLUSION Clinical trial teams in sub-Saharan Africa perceived GCP as a helpful guideline, despite having been developed by northern organisations and despite the high administrative burden of implementing it. To mitigate consent challenges, we suggest adapting GCP and making use of the flexibility it offers.
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Affiliation(s)
- N Vischer
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - C Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - A Joller
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - I Klingmann
- European Forum for Good Clinical Practice, Brussels, Belgium
| | - A Ka
- Département de Sociologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - S K Kpormegbe
- Department of Sociology, University of Ghana, Legon, Ghana
| | - C Burri
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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