Developing capacity for implementation and evaluation of vaccine trials in Uganda: Perspective of the Makerere University Walter Reed Project

Introduction: Infectious diseases and neglected tropical diseases continue to be a major challenge in resource limited settings, causing significant morbidity and mortality. Although vaccines are a key biomedical prevention tool, resource limited settings often lack the infrastructure, regulatory frameworks, and skilled human resource to conduct vaccine clinical trials. To address this gap, the Makerere University Walter Reed Project (MUWRP) was established and has contributed to vaccine research in Uganda and globally. Methods: This was achieved through training a strong vaccine clinical trial workforce; development of requisite clinical trial infrastructure for research activities and management of investigational products; conducting phase I-III vaccine trials and contribution to national ethical and regulatory frameworks that protect participants. Results: As of 2022, MUWRP had successfully conducted and completed five phase I/II HIV vaccine clinical trials, five for Ebola and Marburg, while one phase I/II Schistosomiasis and one phase III COVID-19 vaccine clinical trial are ongoing. Discussion: The completed vaccine trials provided critical scientific knowledge on the safety and immunogenicity of investigational products which informed the design of better vaccines for diseases of global health importance. Conclusion: Academia, through establishment of appropriate partnerships can contribute to the identification of solutions to complex public health challenges

The experiences of teleradiology end users regarding role extension in a rural district of the North West province: a qualitative analysis

Background: Teleradiology was implemented across South Africa, to provide reporting services to rural healthcare institutes without a radiologist. This is guided by standard operating procedure manuals (SOP) which standardise the quality of services provided. From observation, end users, namely, the radiographer and referring clinician, experience challenges in fulfilling the roles extending beyond the SOP. Aim: To explore the end users' experiences within this context and the impact it has on service delivery. Setting: A rural district in North West province, South Africa. Method: This was a qualitative, exploratory, descriptive study. Focus group discussions were held with radiographers and referring clinicians from the teleradiology site in the North West province. A one-on-one interview was conducted with a private radiologist at the reporting site in Gauteng. An interview guide was used to ask open-ended questions to address the aim of the study. Results: At the teleradiology site, radiographers and referring clinicians are performing extended roles, not described in the teleradiology service-level agreement (SLA) and felt poorly equipped to fulfil these roles. They also felt that the private radiologists needed training on interprofessional collaboration to understand the challenges facing health professionals at these rural sites. Conclusion: SLA's should align with the clinical needs and practices of the district. This should guide the specific training needs of the end users practicing in rural areas, to support their extended roles in the teleradiology setting. Training should be in-house, ongoing and consistent to cater for the influx of health professionals entering the rural setting using teleradiology systems

Building focused cardiac ultrasound capacity in a lower middle-income country: a single centre study to assess training impact

Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agree-ment between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training pro-gramme locally. Methods: This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were as-sessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa > 0.6 indicative of good inter-rater agreement. Results: Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties. Conclusions: Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives

Experience de la premiere formation medicale continue en echographie destinee aux medecins generalistes et sages-femmes a l'UFR des sciences de la sante de Saint-Louis

Introduction. L'echographie est une modalite d'imagerie medicale non irradiante avec une innocuite parfaite. Ce travail rapporte la premiere experience de formation en echographie a l'UFR des sciences de la sante de Saint-Louis. L'objectif etait de renforcer les connaissances et savoir-faire en echographie de 11 medecins generalistes et 11 sages-femmes. Methode La formation s'est deroulee sur 13 semaines; avec un tronc commun portant sur les connaissances de base; et la pratique de l'echographie gyneco-obstetricale. A la fin du tronc commun; les sages-femmes debutaient les stages et les medecins poursuivaient la formation en echographie abdomino-pelvienne avant leurs stages. Des tests ont precede et cloture la partie theorique qui s'est deroulee sous forme d'exposes illustres d'images et cas pratiques. L'evaluation reposait sur le nombre d'objectifs atteint et l'assiduite. Resultats : 19 apprenants sur 22 ont valide la formation. Entre le pre-test et le Post-test; il y'avait chez les sages-femmes une progression de la moyenne de 66;6 et de 85;7 chez les medecins. L'assiduite etait satisfaisante. Le meilleur score d'objectif atteint chez une sage-femme etait de 100; et le score minimale chez elles etait de 85;5; avec une moyenne de 97;1 et un ecart type de 4;6. Chez les medecins le meilleur score etait de 95; le plus faible etait de 4;8 avec une moyenne de 72 et un ecart type de 3;1.Conclusion : Cette experience enclenche le processus de regionalisation de la formation medicale continue dans les universites senegalaises facilitant l'acces aux agents de sante a la formation medicale continue

Piloting a new approach for capacity building in entomology and vector control at the level of national malaria control programmes

Following a survey of entomology capacity in the African Region in 1999; a commitment to strengthen capacity was made and the African Network on Vector Resistance to Insecticides (ANVR) was launched in 2000. Its aim was to facilitate Member States to build capacity in vector control and to collaborate with institutions to standardize methods and approaches. In 2006 ANVR assessed capacity with regard to national malaria control programmes. This assessment provided data on the capacity of countries across the Region to undertake vector surveillance. Recommendations to improve the situation followed and in 2007; through the Bill and Melinda Gates Foundation; a project to strengthen infrastructure and capacity was begun. This article outlines the impressive results of the project and its wider implications for adopting similar approaches across the Region