This study demonstrates that patients recognize barriers to understanding but value elements of consent. Further research is needed to develop approaches that meet patients' goals while recognizing the limitations inherent to this context.
PurposeChildren with acute lymphoblastic leukemia (ALL) in low-income countries have
disproportionately lower cure rates than those in high-income countries. At
Butaro Cancer Center of Excellence (BCCOE), physicians treated patients with
ALL with the first arm of the Hunger Protocol, a graduated-intensity method
tailored for resource-limited settings. This article provides the first
published outcomes, to our knowledge, of patients with ALL treated with this
protocol.MethodsThis is a retrospective descriptive study of patients with ALL enrolled at
BCCOE from July 1, 2012 to June 30, 2014; data were collected through
December 31, 2015. Descriptive statistics were used to calculate patient
demographics, disease characteristics, and outcomes; event-free survival was
assessed at 2 years using the Kaplan-Meier method.ResultsForty-two consecutive patients with ALL were included. At the end of the
study period, 19% (eight) were alive without evidence of relapse: three
completed treatment and five were continuing treatment. Among the remaining
patients, 71% (30) had died and 10% (four) were lost to follow-up. A total
of 83% (25) of the deaths were disease related, 3% (one) treatment-related,
and 13% (four) unclear. Event-free survival was 22% (95% CI, 11% to 36%),
considering lost to follow-up as an event, and 26% (95% CI, 13% to 41%) if
lost to follow-up is censored.ConclusionAs expected, relapse was the major cause of failure with this low-intensity
regimen. However, toxicity was acceptably low, and BCCOE has decided to
advance to intensity level 2. These results reflect the necessity of a
data-driven approach and a continual improvement process to care for complex
patients in resource-constrained settings.
Purpose Low- and middle-income countries account for 86% of all cervical cancer cases and 88% of cervical cancer mortality globally. Successful management of cervical cancer requires resources that are scarce in sub-Saharan Africa, especially in rural settings. Here, we describe the early clinical outcomes and implementation lessons learned from the Rwanda Ministry of Health’s first national cancer referral center, the Butaro Cancer Center of Excellence (BCCOE). We hypothesize that those patients presenting at earlier stage and receiving treatment will have higher rates of being alive. Methods The implementation of cervical cancer services included developing partnerships, clinical protocols, pathology services, and tools for monitoring and evaluation. We conducted a retrospective study of patients with cervical cancer who presented at BCCOE between July 1, 2012, and June 30, 2015. Data were collected from the electronic medical record system and by manually reviewing medical records. Descriptive, bivariable and multivariable statistical analyses were conducted to describe patient demographics, disease profiles, treatment, and clinical outcomes. Results In all, 373 patients met the study inclusion criteria. The median age was 53 years (interquartile rage, 45 to 60 years), and 98% were residents of Rwanda. Eighty-nine percent of patients had a documented disease stage: 3% were stage I, 48% were stage II, 29% were stage III, and 8% were stage IV at presentation. Fifty percent of patients were planned to be treated with a curative intent, and 54% were referred to chemoradiotherapy in Uganda. Forty percent of patients who received chemoradiotherapy were in remission. Overall, 25% were lost to follow-up. Conclusion BCCOE illustrates the feasibility and challenges of implementing effective cervical cancer treatment services in a rural setting in a low-income country.
Background
With a decline in malaria burden, innovative interventions and tools are required to reduce malaria transmission further. Mass drug administration (MDA) of artemisinin-based combination therapy (ACT) has been identified as a potential tool to further reduce malaria transmission, where coverage of vector control interventions is already high. However, the impact is limited in time. Combining an ACT with an endectocide treatment that is able to reduce vector survival, such as ivermectin (IVM), could increase the impact of MDA and offer a new tool to reduce malaria transmission.
Objective
The study objective is to evaluate the impact of MDA with IVM plus dihydroartemisinin-piperaquine (DP) on malaria transmission in an area with high coverage of malaria control interventions.
Methods
The study is a cluster randomized trial in the Upper River Region of The Gambia and included 32 villages (16 control and 16 intervention). A buffer zone of ~2 km was created around all intervention clusters. MDA with IVM plus DP was implemented in all intervention villages and the buffer zones; control villages received standard malaria interventions according to the Gambian National Malaria Control Program plans.
Results
The MDA campaigns were carried out from August to October 2018 for the first year and from July to September 2019 for the second year. Statistical analysis will commence once the database is completed, cleaned, and locked.
Conclusions
This is the first cluster randomized clinical trial of MDA with IVM plus DP. The results will provide evidence on the impact of MDA with IVM plus DP on malaria transmission.
Trial Registration
ClinicalTrials.gov NCT03576313; https://clinicaltrials.gov/ct2/show/NCT03576313
International Registered Report Identifier (IRRID)
DERR1-10.2196/20904
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