Dr Sylvie Kwedi

Cameroon

EDCTP portfolio: Career Development Fellowships

Dr Sylvie Kwedi evaluates the effect of integrating informal healthcare providers into the National Tuberculosis Programme of Cameroon in order to improve TB case detection.

Improving TB case detection with informal healthcare providers

With about 35,000 TB cases expected annually, Cameroon is a country with a relatively high incidence and prevalence of tuberculosis. The strategies adopted in Cameroon by the National Tuberculosis Control Program (NTCP) address all facets in the fight against tuberculosis as recommended by the WHO. The NTCP’s main objective of case finding is to identify patients with pulmonary tuberculosis (PTB) who are responsible for the transmission of the infection. However, based on a survey, the NTCP estimates that one of the main bottlenecks in finding TB cases is the fact that many people frequent informal health care providers, who give substandard care.

The challenge

A survey conducted by the NTCP revealed that numerous informal healthcare providers (IHPs) were operating in major cities in Cameroon. The IHPs are not yet integrated into the NTCP network, but they are likely to provide health care to a significant number of TB suspects.

In 2015, Dr Kwedi, in collaboration with the NCTP, conducted a study to assess the feasibility of integrating IHPs into the NTCP in order to improve TB case detection in Yaoundé (intervention city) as compared to Douala (control city). This feasibility study showed that the IHPs were willing to collaborate with the NCTPs. They accepted to be trained, using NCTP tools and referring suspected TB cases to the NTCP for confirmation.

For this study, Dr Kwedi proposed to evaluate the effect of integrating the informal healthcare providers into the NTCP in order to improve TB case detection. The project takes place in three main cities in Cameroon: Douala, Buéa and Bafoussam. Informal healthcare providers receive proper training for handling TB suspects and their ability to refer TB suspects to the NCTP is intensively monitored. The project is a prospective quasi-experimental (pre/post) study to test an intervention that utilises a training tool intended to improve the IHPs ability to handle TB suspects and further refer them to the NCTP for case detection.

The project

The study is innovative in that it taps into a non-traditional TB case-finding strategy in the community. The results from this study will provide actionable evidence that may guide policy to transform the contribution of IHPs from a liability into an asset for TB control. Dr Kwesi expects that a formal path to integrate the IHPs into the official TB control services can be implemented.

Impact


test the safety and efficacy of this new formulation in young children

Bringing antiretroviral drugs to children

The CHAPAS trials have ensured that many more children with HIV have benefited
from life-saving antiretrovirals.

EDCTP portfolio: HIV & HIV-associated infections

The challenge

With about 35,000 TB cases expected annually, Cameroon is a country with a relatively high incidence and prevalence of tuberculosis. The strategies adopted in Cameroon by the National Tuberculosis Control Program (NTCP) address all facets in the fight against tuberculosis as recommended by the WHO. The NTCP’s main objective of case finding is to identify patients with pulmonary tuberculosis (PTB) who are responsible for the transmission of the infection. However, based on a survey, the NTCP estimates that one of the main bottlenecks in finding TB cases is the fact that many people frequent informal health care providers, who give substandard care.

A survey conducted by the NTCP revealed that numerous informal healthcare providers (IHPs) were operating in major cities in Cameroon. The IHPs are not yet integrated into the NTCP network, but they are likely to provide health care to a significant number of TB suspects.

In 2015, Dr Kwedi, in collaboration with the NCTP, conducted a study to assess the feasibility of integrating IHPs into the NTCP in order to improve TB case detection in Yaoundé (intervention city) as compared to Douala (control city). This feasibility study showed that the IHPs were willing to collaborate with the NCTPs. They accepted to be trained, using NCTP tools and referring suspected TB cases to the NTCP for confirmation.

For this study, Dr Kwedi proposed to evaluate the effect of integrating the informal healthcare providers into the NTCP in order to improve TB case detection. The project takes place in three main cities in Cameroon: Douala, Buéa and Bafoussam. Informal healthcare providers receive proper training for handling TB suspects and their ability to refer TB suspects to the NCTP is intensively monitored. The project is a prospective quasi-experimental (pre/post) study to test an intervention that utilises a training tool intended to improve the IHPs ability to handle TB suspects and further refer them to the NCTP for case detection.

The project

The later CHAPAS-3 trial compared the efficacy and safety of three fixed-dose combinations including two without stavudine (found to have some long-term side effects in adults, leading to a recommendation that its use be discontinued in children). The trial the first of its kind in Africa studied nearly 500 children at four sites in two African countries.

The study is innovative in that it taps into a non-traditional TB case-finding strategy in the community. The results from this study will provide actionable evidence that may guide policy to transform the contribution of IHPs from a liability into an asset for TB control. Dr Kwesi expects that a formal path to integrate the IHPs into the official TB control services can be implemented.

ratios forfixed-dose combinations and on appropriatedosage according to weight. 

The CHAPAS-3 trial confirmed the effectiveness of fixed-dose combinations, providing further impetus to the rollout of antiretrovirals to children. Its evidence on abacavir informed the WHO recommendation of abacavir-containing combinations for first-line therapy in children. Trial data have also been used to support applications for regulatory approval for new scored efavirenz tablets.

Impact

L’homme RF et al. Nevirapine, stavudine and lamivudine pharmacokinetics in African children on paediatric fixed-dose combination tablets. AIDS. 2008;22(5):557–65.

Mulenga V et al. Abacavir, zidovudine, or stavudine as paediatric tablets for African HIVinfected children (CHAPAS-3): an open-label, parallel-group, randomised controlled trial. Lancet Infect Dis. 2016;16(2):169–79.

WHO. Guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2010.

WHO. Consolidated guidelines on the use of antiretroviral drugs
for treating and preventing

HIV infection: Recommendations for a public health approach
(second edition). 2016

Projects: Children with HIV in Africa Pharmacokinetics and Adherence of Simple Antiretroviral Regimens (CHAPAS): CHAPAS-1 and -3

Project lead: Professor Chifumbe Chintu, University Teaching Hospital, Zambia (CHAPAS-1); Dr Veronica Mulenga, University Teaching Hospital, Zambia (CHAPAS-3)

Target population(s): Children with HIV

Sample size: 71 (CHAPAS-1); 480 (CHAPAS-3)

Countries involved: Ireland, the Netherlands, the UK, the USA, Zambia (CHAPAS-1); Uganda, Zambia (CHAPAS-3)

Project duration: 2005–2009 (CHAPAS-1); 2010 –2011 (CHAPAS-3)

EDCTP funding: €1.2M (CHAPAS-1); €4.6M (CHAPAS-3)

Total project funding: €1.2M (CHAPAS-1); €5.0M

About us

The European & Developing Countries Clinical Trials Partnership (EDCTP) is a public–public partnership between 14 European and 16 African countries, supported by the European Union. EDCTP’s vision is to reduce the individual, social and economic burden of poverty-related infectious diseases by affecting sub-Saharan Africa. EDCTP’s mission is to accelerate the development of new or improved medicinal products for the identification, treatment and prevention of infectious diseases, including emerging and re-emerging diseases, through pre- and postregistration clinical studies, with emphasis on phase II and III clinical trials. Our approach integrates conduct of research with development of African clinical research capacity and networking. The second EDCTP programme is implemented by the EDCTP Association supported under Horizon 2020, the European Union’s Framework Programme for Research and Innovation.

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