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Onyeneho NG, Aronu NI, Igwe I, Okeibunor J, Diarra T, Diallo B, Hamadou B, Rodrigue B, Djingarey MH, Yoti Z, N’da Dick M, Yao K, Fall S, Gueye AS. Exploring Alternative Care Platforms for Symptomatic People in the Fight against the Ebola Virus Disease Outbreak. J Immunol Sci 2023; Suppl 3:81-87. [PMID: 38333358 PMCID: PMC7615616 DOI: 10.29245/2578-3009/2023/s3.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Treatment centers (TCs) are the only locations designed to care for people with Ebola virus disease (EVD) symptoms. These people and their families are held at a TC as soon as they arrive at an Ebola treatment center (ETC); however, some people escape from TCs. This paper explored alternative care platforms for symptomatic people in the fight against the EVD outbreak in the Democratic Republic of Congo. Eight hundred randomly selected adults aged 18 years and above were surveyed with a uniform set of structured questionnaires. In-depth interviews were conducted with 20 community/opinion leaders, while focus group discussions were held with community members who were not involved in the questionnaire study. Our findings demonstrated that people who were suspected of having EVD preferred to be treated discreetly and at home, and were more willing to be tested at home than at a TC. People were afraid of being stigmatized if the TC exposed their admittance to the general public. This article proposes an alternative to the TCs. We suggest a temporary containment facility within the community, such as a room in the suspected person's home. However, this requires negotiation between the response team and community members, with the latter having a significant responsibility in caring for their symptomatic relatives. The place or room for domestic temporary isolation should be chosen discreetly and placed far from the view of others. Community members will, thus, bear more responsibility for what happens while the patient is in isolation. The temporary containment area will assist in decentralizing the treatment of those with EVD symptoms. Its implementation will contribute to greater accountability of community members in the fight against EVD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Konan Yao
- World Health Organization, Switzerland
| | - Soce Fall
- World Health Organization, Switzerland
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Nikiforow S, Frigault MJ, Frey NV, Gardner RA, Komanduri KV, Perales MA, Kebriaei P, Warkentin PI, Pasquini M, Aho JL, Levine BL, Heslop HE, Hlucky TL, Habucky K, Gharibo M, Jagasia M, Locke FL. Paving the Road for Chimeric Antigen Receptor T Cells: American Society for Transplantation and Cellular Therapy 80/20 Task Force Consensus on Challenges and Solutions to Improving Efficiency of Clinical Center Certification and Maintenance of Operations for Commercially Approved Immune Effector Cell Therapies. Transplant Cell Ther 2023; 29:228-239. [PMID: 36709800 DOI: 10.1016/j.jtct.2023.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/23/2022] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
As the number and type of regulatory authority-approved cellular therapies grow, clinical treatment centers face a heavy burden of duplicative documentation around initial qualification, ongoing auditing, and reporting, with overlapping requirements from each manufacturer to ensure safe use of their specific product, which in the United States are stipulated under individual Food and Drug Administration (FDA) Biologic License Applications. The American Society for Transplantation and Cellular Therapy (ASTCT) convened the 80/20 Task Force to consider challenges and potential solutions to these issues. The Task Force proposed that 80% of manufacturers' requirements for onboarding and ongoing operations of commercially available products could be standardized and streamlined. Task Force members interviewed dozens of stakeholders, including clinicians at large academic medical centers already using commercial and investigational immune effector cell (IEC) products, regulators, members of accrediting bodies and professional cellular therapy societies, and manufacturers of IEC therapies for oncologic indications. In November 2021, the Task Force organized and led virtual discussions in a public forum and at a private ASTCT 80/20 Workshop at the online AcCELLerate Forum, a cellular-therapy stakeholders' meeting organized by the ASTCT, National Marrow Donor Program (NMDP), and Center for International Blood and Marrow Transplant Research (CIBMTR). At the workshop, approximately 60 stakeholders worked to identify and prioritize common challenges in onboarding and maintenance of operations at clinical sites for commercial FDA-approved and future IEC therapies and ways to streamline the process. It was agreed that standardization would improve efficiency of onboarding, allowing more cost-effective, sustainable growth of approved IEC therapies at treatment centers, and facilitate wider access while maintaining safety and clinical success. This early but extensive survey of stakeholders resulted in 5 overarching suggestions for both established and emerging treatment centers: (1) eliminate duplication in accreditation and auditing of clinical sites; (2) define expectations for the education about and management of CAR-T therapy toxicities to potentially replace product-specific REMS programs; (3) streamline current REMS education, testing, and data reporting; (4) standardize information technology (IT) platforms supporting enrollment, clinical site-manufacturer communication, and logistics of maintaining chain of identity/chain of custody across multiple transportation steps; and (5) encourage the use of universal nomenclature by cell therapy manufacturers. Future discussions need to engage a broader range of stakeholders, including administrators, pharmacists, nurses, data coordinators, surgeons, pathologists, and those developing promising cellular therapies for solid tumors, as well as teams from smaller academic or community cancer center settings. Continued collaboration with stakeholders outside of clinical sites will include accrediting bodies/auditors, established and emerging cell therapy companies, software developers, professional societies, and the patients who receive these therapies. Active dialog with government regulators remains essential. Such joint efforts are critical as the number of IEC therapies for myriad oncologic and nononcologic indications grows.
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Affiliation(s)
- Sarah Nikiforow
- Hematologic Malignancies, Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Matthew J Frigault
- Hematopoietic Cell Transplant and Cell Therapy Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Noelle V Frey
- Medicine, Hematology Oncology, University of Pennsylvania, Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Rebecca A Gardner
- Dept Of Pediatrics, Division of Hematology/Oncology, Seattle Children's/University of Washington, Seattle, Washington
| | - Krishna V Komanduri
- Helen Diller Family Comprehensive Cancer Center and Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Partow Kebriaei
- Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Phyllis Irene Warkentin
- Pathology/Microbiology, University of Nebraska Medical Center and Foundation for the Accreditation of Cellular Therapy, Omaha, Nebraska
| | - Marcelo Pasquini
- Medicine, Hematology/Oncology, Center for International Blood & Marrow Transplant Research, Milwaukee, Wisconsin
| | - Joy Lynn Aho
- Product and Innovation, Provider Services, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bruce L Levine
- Pathology and Laboratory Medicine, Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helen E Heslop
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Tracey L Hlucky
- Product Distribution Quality, Site Qualification, Kite Pharma/Gilead, Columbus, Ohio
| | - Karen Habucky
- US Oncology Medical, Cell & Gene, Novartis Pharmaceutical Corporation, East Hanover, New Jersey
| | - Mecide Gharibo
- US Medical Affairs, Hematology, Bristol Myers Squibb, Summit, New Jersey
| | - Madan Jagasia
- Medical Affairs, Iovance Biotherapeutics, San Carlos, California
| | - Frederick L Locke
- Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.
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