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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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Rouard C, Bourgeois-Nicolaos N, Rahajamanana L, Romain O, Pouga L, Derouin V, De Luca D, Doucet-Populaire F. Evaluation of an 'all-in-one' seven-day whole-genome sequencing solution in the investigation of a Staphylococcus aureus outbreak in a neonatal intensive care unit. J Hosp Infect 2019; 102:297-303. [PMID: 30771369 DOI: 10.1016/j.jhin.2019.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Meticillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA) are responsible for outbreaks in intensive care units. MSSA infections have the same morbidity and mortality rate as MRSA infections but are studied less often. Whole-genome sequencing (WGS) is used increasingly for outbreak monitoring, but still requires specific installation and trained personnel to obtain and analyse the data. AIM To evaluate the workflow and benefits of EpiSeq solution (bioMérieux, Marcy l'Etoile, France) in exploring the increased incidence of S. aureus bloodstream infections in a neonatal intensive care unit (NICU). METHODS Four S. aureus bacteraemia isolates and 27 colonization isolates obtained between January and July 2016 were submitted to the 'all in one solution' EpiSeq [WGS, quality data assessment, multi-locus sequence typing (MLST), spa typing, virulome and resistome characterization, and phylogenetic tree construction]. More in-depth analyses were performed (whole-genome MLST and whole-genome single nucleotide polymorphism (wgSNP)] with BioNumerics software (Applied Maths, Sint-Martens-Latem, Belgium). FINDINGS Nine different sequence types and 13 different spa types were found among the 31 isolates studied. Among those isolates, 11 (seven patients) were ST146 spa type t002, five (four patients) were ST30 and four (four patients) were ST398. The 11 ST146 isolates had a maximum of seven pairwise SNP differences. CONCLUSION Use of EpiSeq solution allowed fast demonstration of the polyclonal profile of the MSSA population in neonates, and enabled the suspicion of a global outbreak to be ruled out. However, wgSNP analysis showed the transmission and persistence of one sequence type for over six months in the NICU, and enabled the infection control team to adapt its response.
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Affiliation(s)
- C Rouard
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France; EA4043, Bactéries pathogènes et santé, Faculté de Pharmacie, Université Paris Sud, Chatenay-Malabry, France
| | - N Bourgeois-Nicolaos
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France; EA4043, Bactéries pathogènes et santé, Faculté de Pharmacie, Université Paris Sud, Chatenay-Malabry, France; Institute of Integrative Biology of the Cell, CNRS, CEA, Université Paris Sud, Paris Saclay University, Gif sur Yvette, France
| | - L Rahajamanana
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France
| | - O Romain
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Division of Paediatrics and Neonatal Intensive Care, Clamart, France
| | - L Pouga
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France
| | - V Derouin
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France
| | - D De Luca
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Division of Paediatrics and Neonatal Intensive Care, Clamart, France; INSERM-U999 LabEx - LERMIT, Clamart, France
| | - F Doucet-Populaire
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France; EA4043, Bactéries pathogènes et santé, Faculté de Pharmacie, Université Paris Sud, Chatenay-Malabry, France; Institute of Integrative Biology of the Cell, CNRS, CEA, Université Paris Sud, Paris Saclay University, Gif sur Yvette, France.
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Jauréguy F, Mansour H, Bigot J, Walewski V, Billard-Pomares T, Rahajamanana L, Picard B, Carbonnelle E. Use of the Xpert CarbaR assay for direct detection of carbapenemase genes from blood cultures and urine samples. J Hosp Infect 2017; 98:245-246. [PMID: 28970052 DOI: 10.1016/j.jhin.2017.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Affiliation(s)
- F Jauréguy
- Service de Bactériologie-Virologie, Hygiène, Hôpitaux Universitaires de Paris Seine Denis (HUPSSD), site Avicenne, AP-HP, Bobigny, France; Université Paris Nord, IAME, UMR 1137, Sorbonne Paris Cité, France.
| | - H Mansour
- Service de Bactériologie-Virologie, Hygiène, Hôpitaux Universitaires de Paris Seine Denis (HUPSSD), site Avicenne, AP-HP, Bobigny, France
| | - J Bigot
- Service de Bactériologie-Virologie, Hygiène, Hôpitaux Universitaires de Paris Seine Denis (HUPSSD), site Avicenne, AP-HP, Bobigny, France
| | - V Walewski
- Service de Bactériologie-Virologie, Hygiène, Hôpitaux Universitaires de Paris Seine Denis (HUPSSD), site Avicenne, AP-HP, Bobigny, France; Université Paris Nord, IAME, UMR 1137, Sorbonne Paris Cité, France
| | - T Billard-Pomares
- Service de Bactériologie-Virologie, Hygiène, Hôpitaux Universitaires de Paris Seine Denis (HUPSSD), site Avicenne, AP-HP, Bobigny, France; Université Paris Nord, IAME, UMR 1137, Sorbonne Paris Cité, France
| | - L Rahajamanana
- Service de Bactériologie-Virologie, Hygiène, Hôpitaux Universitaires de Paris Seine Denis (HUPSSD), site Avicenne, AP-HP, Bobigny, France
| | - B Picard
- Service de Bactériologie-Virologie, Hygiène, Hôpitaux Universitaires de Paris Seine Denis (HUPSSD), site Avicenne, AP-HP, Bobigny, France; Université Paris Nord, IAME, UMR 1137, Sorbonne Paris Cité, France
| | - E Carbonnelle
- Service de Bactériologie-Virologie, Hygiène, Hôpitaux Universitaires de Paris Seine Denis (HUPSSD), site Avicenne, AP-HP, Bobigny, France; Université Paris Nord, IAME, UMR 1137, Sorbonne Paris Cité, France
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