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Ariza-Vioque E, Ello F, Andriamamonjisoa H, Machault V, González-Martín J, Calvo-Cortés MC, Eholié S, Tchabert GA, Ouassa T, Raberahona M, Rakotoarivelo R, Razafindrakoto H, Rahajamanana L, Wilkinson RJ, Davis A, Maxebengula M, Abrahams F, Muzoora C, Nakigozi N, Nyehangane D, Nanjebe D, Mbega H, Kaitano R, Bonnet M, Debeaudrap P, Miró JM, Anglaret X, Rakotosamimanana N, Calmy A, Bonnet F, Ambrosioni J. Capacity Building in Sub-Saharan Africa as Part of the INTENSE-TBM Project During the COVID-19 Pandemic. Infect Dis Ther 2022; 11:1327-1341. [PMID: 35767219 PMCID: PMC9244532 DOI: 10.1007/s40121-022-00667-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
Tuberculous meningitis (TBM) is the most severe and disabling form of tuberculosis (TB), with at least 100,000 cases per year and a mortality rate of up to 50% in individuals co-infected with human immunodeficiency virus type 1 (HIV-1). To evaluate the efficacy and safety of an intensified anti-tubercular regimen and an anti-inflammatory treatment, the INTENSE-TBM project includes a phase III randomised clinical trial (TBM-RCT) in four countries in sub-Saharan Africa (SSA). Within this framework, we designed a comprehensive capacity-building work package ensuring all centres had, or would acquire, the ability to conduct the TBM-RCT and developing a network of skilled researchers, clinical centres and microbiology laboratories. Here, we describe these activities, identify strengths/challenges and share tools adaptable to other projects, particularly in low- and lower-middle income countries with heterogeneous settings and during the coronavirus disease 2019 (COVID-19) pandemic. Despite major challenges, TBM-RCT initiation was achieved in all sites, promoting enhanced local healthcare systems and encouraging further clinical research in SSA. In terms of certified trainings, the achievement levels were 95% (124/131) for good clinical practice, 91% (39/43) for good clinical laboratory practice and 91% (48/53) for infection prevention and control. Platform-based research, developed as part of capacity-building activities for specific projects, may be a valuable tool in fighting future infectious diseases and in developing high-level research in Africa. The INTENSE-TBM project aimed to design a comprehensive work-package on capacity building, ensuring all centres would acquire the ability to conduct a phase III randomised clinical trial on TBM in sub-Saharan Africa, to reduce tuberculous meningitis mortality and morbidity in patients with/without HIV-1 co-infection. Therefore, the INTENSE-TBM project is an example of how an international clinical research consortium can provide opportunities to enhance local capacity building and promote centres without previous experience in clinical research. This article provides practical approaches for implementing effective capacity-building programmes. We highlight how to overcome limitations imposed by the COVID-19 pandemic to successfully complete clinics, laboratory set-ups and personnel training, so as to optimise resources and empower African institutions on a local level. At the same time, our experience shows how capacity-building programmes can deliver long-lasting impact that extends beyond the original aims of the project (e.g. HIV and TB), and support local health systems in fighting other infectious disease (e.g. COVID-19). Research projects in low- and lower-middle income countries with heterogeneous settings could stand to benefit the most.
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Affiliation(s)
- E Ariza-Vioque
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - F Ello
- Programme ANRS Coopération Côte d'Ivoire (PAC-CI), Abidjan, Ivory Coast
| | | | - V Machault
- INSERM U1219, Bordeaux Population Health (BPH), Université de Bordeaux, Bordeaux, France
| | - J González-Martín
- Servei de Microbiologia, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut de Salut Global (ISGlobal), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - M C Calvo-Cortés
- Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS), Maladies Infectieuses Émergentes, Paris, France
| | - S Eholié
- Centre Hospitalier Universitaire (CHU) Treichville, Abidjan, Ivory Coast
| | - G A Tchabert
- Programme ANRS Coopération Côte d'Ivoire (PAC-CI), Abidjan, Ivory Coast
| | - T Ouassa
- Centre de Diagnostic et de Research sur le SIDA et les autres maladies infectieuses (CeDReS), Abidjan, Ivory Coast
| | - M Raberahona
- Centre d'Infectiologie Charles Mérieux (CICM), Antananarivo, Madagascar
- Université d'Antananarivo, Antananarivo, Madagascar
- Centre Hospitalier Universitaire (CHU) Joseph Raseta Befalatanana, Antananarivo, Madagascar
| | - R Rakotoarivelo
- Université de Fianarantsoa, Fianarantsoa, Madagascar
- Centre Hospitalier Universitaire (CHU) Tambohobe, Fianarantsoa, Madagascar
| | - H Razafindrakoto
- Centre d'Infectiologie Charles Mérieux (CICM), Antananarivo, Madagascar
| | - L Rahajamanana
- Centre d'Infectiologie Charles Mérieux (CICM), Antananarivo, Madagascar
| | - R J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Cape Town, Republic of South Africa
- Francis Crick Institute, London, UK
- Department Infectious Diseases, Imperial College London, London, UK
| | - A Davis
- Wellcome Centre for Infectious Diseases Research in Africa, Cape Town, Republic of South Africa
| | - M Maxebengula
- Wellcome Centre for Infectious Diseases Research in Africa, Cape Town, Republic of South Africa
| | - F Abrahams
- Wellcome Centre for Infectious Diseases Research in Africa, Cape Town, Republic of South Africa
| | - C Muzoora
- Médecins Sans Frontières (MSF) Epicentre, Mbarara, Uganda
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - N Nakigozi
- Médecins Sans Frontières (MSF) Epicentre, Mbarara, Uganda
| | - D Nyehangane
- Médecins Sans Frontières (MSF) Epicentre, Mbarara, Uganda
| | - D Nanjebe
- Médecins Sans Frontières (MSF) Epicentre, Mbarara, Uganda
| | - H Mbega
- Médecins Sans Frontières (MSF) Epicentre, Mbarara, Uganda
| | - R Kaitano
- Médecins Sans Frontières (MSF) Epicentre, Mbarara, Uganda
| | - M Bonnet
- Université de Montpellier, Montpellier, France
- Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIHMI), Institut de Recherche pour le Développement (IRD), INSERM, Paris, France
| | - P Debeaudrap
- Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIHMI), Institut de Recherche pour le Développement (IRD), INSERM, Paris, France
| | - J M Miró
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - X Anglaret
- Programme ANRS Coopération Côte d'Ivoire (PAC-CI), Abidjan, Ivory Coast
- INSERM U1219, Bordeaux Population Health (BPH), Université de Bordeaux, Bordeaux, France
| | | | - A Calmy
- Université de Genève (UNIGE), Geneva, Switzerland
| | - F Bonnet
- INSERM U1219, Bordeaux Population Health (BPH), Université de Bordeaux, Bordeaux, France
- Service de Médecine Interne et Maladies Infectieuses, Saint-André Hospital, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - J Ambrosioni
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
- HIV Unit, Infectious Diseases Service, Hospital Clínic de Barcelona, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
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