1
|
Zemsi A, Nekame LJG, Mohammed N, Batchilly ES, Dabira E, Sillah SO, Sey G, Williams DH, Dondeh BL, Cerami C, Clarke E, D'Alessandro U. Practical Guidelines for Standardised Resolution of Important Protocol Deviations in Clinical Trials Conducted in Sub-Saharan Africa. Ther Innov Regul Sci 2024; 58:395-403. [PMID: 38285370 PMCID: PMC11043146 DOI: 10.1007/s43441-023-00604-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024]
Abstract
A clinical trial is any research on human subjects that involves an investigational medicinal product or device. Investigational medicinal products include unlicensed drugs or drugs used outside the product license (e.g. for a new indication) (ICH-GCP). As per the internationally accepted ICH-GCP guidelines, clinical trials should be conducted strictly per the approved protocol. However, during the lifecycle of a trial, protocol deviations may occur. Under ICH efficacy guidelines, protocol deviations are divided into non-important (minor) or important (major), and the latter can jeopardise the participant's rights, safety or the quality of data generated by the study. Existing guidelines on protocol deviation management do not detail or standardise actions to be taken for participants, investigational products, data or samples as part of a holistic management of important protocol deviations. Herein, we propose guidelines to address the current literature gap and promote the standardisation of actions to address important protocol deviations in clinical trials. The advised actions should complement the existing local institutional review board and national regulatory authority requirements.
Collapse
Affiliation(s)
- Armel Zemsi
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia.
| | | | - Nuredin Mohammed
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | | | - Edgard Dabira
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Sheikh Omar Sillah
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Gibbi Sey
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Daisy H Williams
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Bai-Lamin Dondeh
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Carla Cerami
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Ed Clarke
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | | |
Collapse
|
2
|
Secka F, Herberg JA, Sarr I, Darboe S, Sey G, Saidykhan M, Wathuo M, Kaforou M, Antonio M, Roca A, Zaman SMA, Cebey-López M, Boeddha NP, Paulus S, Kohlfürst DS, Emonts M, Zenz W, Carrol ED, de Groot R, Schlapbach L, Martinon-Torres F, Bojang K, Levin M, van der Flier M, Anderson ST. Bacteremia in Childhood Life-Threatening Infections in Urban Gambia: EUCLIDS in West Africa. Open Forum Infect Dis 2019; 6:ofz332. [PMID: 31660408 PMCID: PMC6798247 DOI: 10.1093/ofid/ofz332] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/23/2019] [Indexed: 01/13/2023] Open
Abstract
Background The limited availability of microbiology services in sub-Saharan Africa impedes accurate diagnosis of bacterial pathogens and understanding of trends in prevalence and antibiotic sensitivities. We aimed to characterize bacteremia among hospitalized children in The Gambia and to identify factors associated with bacteremia and mortality. Methods We prospectively studied children presenting with suspected severe infection to 2 urban hospitals in The Gambia, between January 2013 and September 2015. Demographic and anthropometric data, clinical features, management, and blood culture results were documented. Urine screens for antibiotic activity were performed in a subset of participants. Results Of 411 children enrolled (median age, 29 months; interquartile range, 11–82), 79.5% (325 of 409) reported prehospital antibiotic use. Antimicrobial activity by urinary screen for antibiotic activity was detected in 70.8% (n = 80 of 113). Sixty-six bacterial pathogens were identified in 65 (15.8%) participants and Staphylococcus aureus predominated. Gram-positive organisms were more commonly identified than Gram-negative (P < .01). Antibiotic resistance against first-line antimicrobials (ampicillin and gentamicin) was common among Gram-negative bacteria (39%; range, 25%–100%). Factors significantly associated with bacteremia included the following: gender, hydration status, musculoskeletal examination findings, admission to the Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine hospital, and meeting sepsis criteria. Those associated with increased mortality were presence of a comorbidity, clinical pallor, tachypnea, and altered consciousness. Tachycardia was associated with reduced mortality. Conclusions The bacteremia rate in children with suspected childhood life-threatening infectious diseases in The Gambia is high. The pattern of pathogen prevalence and antimicrobial resistance has changed over time compared with previous studies illustrating the importance of robust bacterial surveillance programs in resource-limited settings.
Collapse
Affiliation(s)
- F Secka
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - J A Herberg
- Imperial College London, Section of Paediatric Infectious Disease, United Kingdom
| | - I Sarr
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - S Darboe
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - G Sey
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - M Saidykhan
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - M Wathuo
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - M Kaforou
- Imperial College London, Section of Paediatric Infectious Disease, United Kingdom
| | - M Antonio
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - A Roca
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - S M A Zaman
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - M Cebey-López
- Instituto de Investigación Sanitaria de Santiago, Genetics-Vaccines-Infectious Diseases and Paediatrics Research Group, GENVIP, Spain
| | - N P Boeddha
- Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Intensive Care and Department of Paediatric Surgery, The Netherlands
| | - S Paulus
- University of Liverpool Institute of Infection and Global Health, Department of Clinical Infection Microbiology and Immunology, United Kingdom
| | - D S Kohlfürst
- Medical University of Graz, Department of General Paediatrics, Austria
| | - M Emonts
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Paediatric Infectious Diseases and Immunology Department, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children's Hospital, United Kingdom
| | - W Zenz
- Medical University of Graz, Department of General Paediatrics, Austria
| | - E D Carrol
- University of Liverpool Institute of Infection and Global Health, Department of Clinical Infection Microbiology and Immunology, United Kingdom
| | - R de Groot
- Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, and Expertise Center for Immunodeficiency and Autoinflammation, and Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - L Schlapbach
- University Children's Hospital Zurich and the Children's Research Center, Switzerland
| | - F Martinon-Torres
- Instituto de Investigación Sanitaria de Santiago, Genetics-Vaccines-Infectious Diseases and Paediatrics Research Group, GENVIP, Spain
| | - K Bojang
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - M Levin
- Imperial College London, Section of Paediatric Infectious Disease, United Kingdom
| | - M van der Flier
- Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, and Expertise Center for Immunodeficiency and Autoinflammation, and Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - S T Anderson
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| |
Collapse
|
4
|
Idoko OT, Owolabi OA, Odutola AA, Ogundare O, Worwui A, Saidu Y, Smith-Sanneh A, Tunkara A, Sey G, Sanyang A, Mendy P, Ota MOC. Lessons in participant retention in the course of a randomized controlled clinical trial. BMC Res Notes 2014; 7:706. [PMID: 25298043 PMCID: PMC4200120 DOI: 10.1186/1756-0500-7-706] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 09/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trials are increasingly being conducted as new products seek to enter the market. Deployment of such interventions is based on evidence obtained mainly from the gold standard of randomized controlled clinical trials (RCCT). A crucial factor in the ability of RCCTs to provide credible and generalisable data is sample size and retention of the required number of subjects at completion of the follow-up period. However, recruitment and retention in clinical trials are hindered by prevalent peculiar challenges in Africa that need to be circumvented. This article shares experiences from a phase II trial that recorded a high retention rate at 14 months follow-up at a new clinical trial site. METHODS Mothers bringing children less than two months of age to the health facility were given information and invited to have their child enrolled if the inclusion criteria were fulfilled. Participants were enrolled over 8 months. Trial procedures, duration and risks/benefits were painstakingly and sequentially explained to the communities, parents and relevant relatives before and during the trial period. The proportions of participants that completed or did not complete the trial were analyzed including the reasons for failure to complete all trial procedures. RESULTS 1044 individuals received information regarding the trial of which 371 returned for screening. 300 (81%) of them who fulfilled the inclusion criteria and did not meet any exclusion criteria were enrolled and 94% of these completed the trial. Consent withdrawal was the main reason for not completing the trial largely (75%) due to the father not being involved at the point of consenting or parents no longer being comfortable with blood sampling. CONCLUSIONS Participant retention in clinical trials remains a crucial factor in ensuring generalisability of trial data. Appropriate measures to enhance retention should include continuous community involvement in the process, adequate explanation of trial procedures and risks/benefits; and innovative tracing of participants adapted for the setting.
Collapse
|