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Mercer T, Gardner A, Andama B, Chesoli C, Christoffersen-Deb A, Dick J, Einterz R, Gray N, Kimaiyo S, Kamano J, Maritim B, Morehead K, Pastakia S, Ruhl L, Songok J, Laktabai J. Leveraging the power of partnerships: spreading the vision for a population health care delivery model in western Kenya. Global Health 2018; 14:44. [PMID: 29739421 PMCID: PMC5941561 DOI: 10.1186/s12992-018-0366-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Academic Model Providing Access to Healthcare (AMPATH) has been a model academic partnership in global health for nearly three decades, leveraging the power of a public-sector academic medical center and the tripartite academic mission - service, education, and research - to the challenges of delivering health care in a low-income setting. Drawing our mandate from the health needs of the population, we have scaled up service delivery for HIV care, and over the last decade, expanded our focus on non-communicable chronic diseases, health system strengthening, and population health more broadly. Success of such a transformative endeavor requires new partnerships, as well as a unification of vision and alignment of strategy among all partners involved. Leveraging the Power of Partnerships and Spreading the Vision for Population Health. We describe how AMPATH built on its collective experience as an academic partnership to support the public-sector health care system, with a major focus on scaling up HIV care in western Kenya, to a system poised to take responsibility for the health of an entire population. We highlight global trends and local contextual factors that led to the genesis of this new vision, and then describe the key tenets of AMPATH's population health care delivery model: comprehensive, integrated, community-centered, and financially sustainable with a path to universal health coverage. Finally, we share how AMPATH partnered with strategic planning and change management experts from the private sector to use a novel approach called a 'Learning Map®' to collaboratively develop and share a vision of population health, and achieve strategic alignment with key stakeholders at all levels of the public-sector health system in western Kenya. CONCLUSION We describe how AMPATH has leveraged the power of partnerships to move beyond the traditional disease-specific silos in global health to a model focused on health systems strengthening and population health. Furthermore, we highlight a novel, collaborative tool to communicate our vision and achieve strategic alignment among stakeholders at all levels of the health system. We hope this paper can serve as a roadmap for other global health partners to develop and share transformative visions for improving population health globally.
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Affiliation(s)
- Tim Mercer
- Department of Population Health, The University of Texas at Austin Dell Medical School, 1701 Trinity St, Austin, TX, 78712, USA.
| | - Adrian Gardner
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr, Indianapolis, IN, 46202, USA.,Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Benjamin Andama
- Academic Model Providing Access to Health Care (AMPATH), PO Box 4606 30100, Eldoret, Kenya
| | - Cleophas Chesoli
- Academic Model Providing Access to Health Care (AMPATH), PO Box 4606 30100, Eldoret, Kenya
| | - Astrid Christoffersen-Deb
- Department of Obstetrics and Gynaecology, University of Toronto Faculty of Medicine, 123 Edward Street, Suite 1200, Toronto, ON, M5G1E2, Canada.,Department of Reproductive Health, Moi University School of Medicine, Eldoret, Kenya
| | - Jonathan Dick
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr, Indianapolis, IN, 46202, USA.,Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Robert Einterz
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Nick Gray
- Dow AgroSciences, 9330 Zionsville Rd, Indianapolis, IN, 46268, USA
| | - Sylvester Kimaiyo
- Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Jemima Kamano
- Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Beryl Maritim
- Academic Model Providing Access to Health Care (AMPATH), PO Box 4606 30100, Eldoret, Kenya
| | - Kirk Morehead
- Dow AgroSciences, 9330 Zionsville Rd, Indianapolis, IN, 46268, USA
| | - Sonak Pastakia
- Purdue University College of Pharmacy, 575 Stadium Mall Dr, West Lafayette, IN, 47907, USA.,Department of Pharmacology, Moi University School of Medicine, Eldoret, Kenya
| | - Laura Ruhl
- Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Dr, Indianapolis, IN, 46202, USA.,Department of Child Health and Paediatrics, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Julia Songok
- Department of Child Health and Paediatrics, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Jeremiah Laktabai
- Department of Family Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
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Tapela NM, Mpunga T, Karema N, Nzayisenga I, Fadelu T, Uwizeye FR, Hirschhorn LR, Muhimpundu MA, Balinda JP, Amoroso C, Wagner CM, Binagwaho A, Shulman LN. Implementation Science for Global Oncology: The Imperative to Evaluate the Safety and Efficacy of Cancer Care Delivery. J Clin Oncol 2015; 34:43-52. [PMID: 26578617 DOI: 10.1200/jco.2015.61.7738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science-the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed-is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. METHODS The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. RESULTS Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. CONCLUSION Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.
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Affiliation(s)
- Neo M Tapela
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA.
| | - Tharcisse Mpunga
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Nadine Karema
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Ignace Nzayisenga
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Temidayo Fadelu
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Frank R Uwizeye
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Lisa R Hirschhorn
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Marie Aimee Muhimpundu
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Jean Paul Balinda
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Cheryl Amoroso
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Claire M Wagner
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Agnes Binagwaho
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Lawrence N Shulman
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
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Chite Asirwa F, Greist A, Busakhala N, Rosen B, Loehrer PJ. Medical Education and Training: Building In-Country Capacity at All Levels. J Clin Oncol 2015; 34:36-42. [PMID: 26578616 DOI: 10.1200/jco.2015.63.0152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Poorly trained workers and limited workforce capacity contribute immensely to barriers in cancer control in low- and middle-income countries (LMICs). Because of an increasing disease burden and the gap in trained personnel, it is critical that LMICs must develop appropriate in-country training programs at all levels to adequately address their cancer-related outcomes. The training in LMICs of cancer health personnel should address priority cancer diseases in the specific country by developing caregivers, trainers, researchers, and administrators at all levels of health care and all cadres of staff, from the community level to the national level. The Academic Model of Providing Access to Health care is a representative model of how a public tertiary hospital like the Moi Teaching and Referral Hospital in an LMIC setting can leverage its resources, collaborate with partners from high-resource countries, and assist in the development of a training center to spearhead a sustainable education program.
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Affiliation(s)
- Fredrick Chite Asirwa
- Fredrick Chite Asirwa, Indiana University; Anne Greist, Indiana Hemophilia and Thrombosis Center; and Patrick J. Loehrer Sr, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Naftali Busakhala and Frederick Chite Asirwa, Moi Teaching and Referral Hospital, Eldoret, Kenya; and Barry Rosen, Princess Margaret Cancer Center and University of Toronto, Toronto, Ontario, Canada.
| | - Anne Greist
- Fredrick Chite Asirwa, Indiana University; Anne Greist, Indiana Hemophilia and Thrombosis Center; and Patrick J. Loehrer Sr, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Naftali Busakhala and Frederick Chite Asirwa, Moi Teaching and Referral Hospital, Eldoret, Kenya; and Barry Rosen, Princess Margaret Cancer Center and University of Toronto, Toronto, Ontario, Canada
| | - Naftali Busakhala
- Fredrick Chite Asirwa, Indiana University; Anne Greist, Indiana Hemophilia and Thrombosis Center; and Patrick J. Loehrer Sr, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Naftali Busakhala and Frederick Chite Asirwa, Moi Teaching and Referral Hospital, Eldoret, Kenya; and Barry Rosen, Princess Margaret Cancer Center and University of Toronto, Toronto, Ontario, Canada
| | - Barry Rosen
- Fredrick Chite Asirwa, Indiana University; Anne Greist, Indiana Hemophilia and Thrombosis Center; and Patrick J. Loehrer Sr, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Naftali Busakhala and Frederick Chite Asirwa, Moi Teaching and Referral Hospital, Eldoret, Kenya; and Barry Rosen, Princess Margaret Cancer Center and University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Loehrer
- Fredrick Chite Asirwa, Indiana University; Anne Greist, Indiana Hemophilia and Thrombosis Center; and Patrick J. Loehrer Sr, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Naftali Busakhala and Frederick Chite Asirwa, Moi Teaching and Referral Hospital, Eldoret, Kenya; and Barry Rosen, Princess Margaret Cancer Center and University of Toronto, Toronto, Ontario, Canada
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