1
|
Ravinetto R, Henriquez R, Srinivas PN, Bradley H, Coetzee R, Ochoa TJ, Semuto Ngabonziza JC, Mazarati JB, Van Damme W, van de Pas R, Vandaele N, Torreele E. Shaping the future of global access to safe, effective, appropriate and quality health products. BMJ Glob Health 2024; 9:e014425. [PMID: 38195155 PMCID: PMC10807033 DOI: 10.1136/bmjgh-2023-014425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Rodrigo Henriquez
- Maestría de Epidemiología y Salud Colectiva, Universidad Andina Simón Bolívar, Quito, Ecuador
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Hazel Bradley
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Renier Coetzee
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Theresa J Ochoa
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jean Claude Semuto Ngabonziza
- Research, Innovation and Data Science Division, Rwanda Biomedical Center, Kigali, Rwanda
- Department of Clinical Biology, University of Rwanda, Kigali, Rwanda
| | | | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Nico Vandaele
- Access-To-Medicines Research Centre, KU Leuven, Leuven, Belgium
| | - Els Torreele
- , Institute for Innovation and Public Purpose, University College London, London, UK
- Independent Researcher and Advisor, Geneva, Switzerland
| |
Collapse
|
2
|
Guttieres D, Diepvens C, Decouttere C, Vandaele N. Modeling Supply and Demand Dynamics of Vaccines against Epidemic-Prone Pathogens: Case Study of Ebola Virus Disease. Vaccines (Basel) 2023; 12:24. [PMID: 38250837 PMCID: PMC10819028 DOI: 10.3390/vaccines12010024] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Health emergencies caused by epidemic-prone pathogens (EPPs) have increased exponentially in recent decades. Although vaccines have proven beneficial, they are unavailable for many pathogens. Furthermore, achieving timely and equitable access to vaccines against EPPs is not trivial. It requires decision-makers to capture numerous interrelated factors across temporal and spatial scales, with significant uncertainties, variability, delays, and feedback loops that give rise to dynamic and unexpected behavior. Therefore, despite progress in filling R&D gaps, the path to licensure and the long-term viability of vaccines against EPPs continues to be unclear. This paper presents a quantitative system dynamics modeling framework to evaluate the long-term sustainability of vaccine supply under different vaccination strategies. Data from both literature and 50 expert interviews are used to model the supply and demand of a prototypical Ebolavirus Zaire (EBOV) vaccine. Specifically, the case study evaluates dynamics associated with proactive vaccination ahead of an outbreak of similar magnitude as the 2018-2020 epidemic in North Kivu, Democratic Republic of the Congo. The scenarios presented demonstrate how uncertainties (e.g., duration of vaccine-induced protection) and design criteria (e.g., priority geographies and groups, target coverage, frequency of boosters) lead to important tradeoffs across policy aims, public health outcomes, and feasibility (e.g., technical, operational, financial). With sufficient context and data, the framework provides a foundation to apply the model to a broad range of additional geographies and priority pathogens. Furthermore, the ability to identify leverage points for long-term preparedness offers directions for further research.
Collapse
Affiliation(s)
- Donovan Guttieres
- Access-to-Medicines Research Centre, Faculty of Economics & Business, KU Leuven, 3000 Leuven, Belgium; (C.D.); (C.D.); (N.V.)
| | | | | | | |
Collapse
|
3
|
Bwire GM, Aiko BG, Mosha IH, Kilapilo MS, Mangara A, Kazonda P, Swai JP, Swalehe O, Jordan MR, Vercauteren J, Sando D, Temba D, Shao A, Mauka W, Decouttere C, Vandaele N, Sangeda RZ, Killewo J, Vandamme AM. High viral suppression and detection of dolutegravir-resistance associated mutations in treatment-experienced Tanzanian adults living with HIV-1 in Dar es Salaam. Sci Rep 2023; 13:20493. [PMID: 37993493 PMCID: PMC10665358 DOI: 10.1038/s41598-023-47795-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023] Open
Abstract
To curb HIV infection rate in Tanzania, antiretroviral therapy (ART) has been scaled up since 2006, and in 2019, the country shifted to regimen including dolutegravir as a default first line. We assessed the success of ART and the contribution of HIV drug resistance (HIVDR) to unsuppressed viral loads. Between February and May 2023 a cross-sectional survey with random sampling was conducted in the six clinics in an urban cohort in Dar es Salaam. Patients with unsuppresed viral loads (local criteria viral load (VL) ≥ 1000 copies/mL) were tested for HIVDR mutations using the WHO adapted protocol for plasma samples. Mutations were interpreted using the Stanford HIVDR database. In total 600 individuals participated in this survey, the majority were female (76.83%), mean age ([Formula: see text] standard deviation) was 44.0 ([Formula: see text] 11.6) years. The median duration on ART (interquartile range) was 6.5 (3.9-10.2) years. Approximately 99% were receiving tenofovir + lamivudine + dolutegravir as a fixed dose combination. VL testing was successful in 99.67% (598/600) of survey patients and only 33 had VL ≥ 1000 copies/mL, resulting in a viral suppression level of 94.48% (565/598, 95% CI 92.34-96.17%). For 23 samples, protease and reverse transcriptase (RT) genotyping were successful, with 13 sequences containing RT inhibitor surveillance drug resistance mutations (SDRMs) (56.5%). No SDRM against protease inhibitors were detected. Thirty samples were successfully genotyped for integrase with 3 sequences (10.08%) containing integrase strand transfer inhibitor (INSTI) SDRMs. In samples successfully genotyped in the three genetic regions, 68.18% (16/22) had a genotypic susceptibility score (GSS) ≥ 2.5 for the concurrent regimen, implying factors beyond drug resistance caused the unsuppressed viral load. For five patients, GSS indicated that HIVDR may have caused the unsuppressed viral load. All three patients with INSTI resistance mutations were highly resistant to dolutegravir and accumulated nucleoside and non-nucleoside RT inhibitor HIVDR mutations. Although in this cohort the last 95 UNAIDS target was almost achieved, HIVDR mutations, including INSTIs resistance mutations were detected in HIV-positive individuals taking ART for at least one year. We recommend the design and implementation of high-impact interventions to prevent the increase of HIVDR, failure of dolutegravir and address the non-resistance factors in the study area.
Collapse
Affiliation(s)
- George M Bwire
- Laboratory of Clinical and Epidemiological Virology (Rega Institute), Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, Rega-Herestraat 49-Bus 1040, 3000, Leuven, Belgium.
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania.
| | - Beatrice Godwin Aiko
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000, Leuven, Belgium
| | - Idda H Mosha
- Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65015, Tanzania
| | - Mary S Kilapilo
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania
| | - Alli Mangara
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Dar es Salaam Urban Cohort Study, Dar es Salaam, 65013, Tanzania
| | - Patrick Kazonda
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Dar es Salaam Urban Cohort Study, Dar es Salaam, 65013, Tanzania
| | - Janeth P Swai
- Department of Business Studies, School of Business, Mzumbe University, Dar es Salaam, 20266, Tanzania
| | - Omary Swalehe
- Department of Business Studies, School of Business, Mzumbe University, Dar es Salaam, 20266, Tanzania
| | | | - Jurgen Vercauteren
- Laboratory of Clinical and Epidemiological Virology (Rega Institute), Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, Rega-Herestraat 49-Bus 1040, 3000, Leuven, Belgium
| | - David Sando
- Managament and Development for Health, Mwai Kibaki Road, Dar es Salaam, Tanzania
| | - David Temba
- Managament and Development for Health, Mwai Kibaki Road, Dar es Salaam, Tanzania
| | - Amani Shao
- Managament and Development for Health, Mwai Kibaki Road, Dar es Salaam, Tanzania
| | - Wilhellmuss Mauka
- Managament and Development for Health, Mwai Kibaki Road, Dar es Salaam, Tanzania
| | - Catherine Decouttere
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000, Leuven, Belgium
| | - Nico Vandaele
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000, Leuven, Belgium
| | - Raphael Z Sangeda
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65015, Tanzania
| | - Anne-Mieke Vandamme
- Laboratory of Clinical and Epidemiological Virology (Rega Institute), Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, Rega-Herestraat 49-Bus 1040, 3000, Leuven, Belgium
- Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
4
|
Heyerdahl LW, Dielen S, Dodion H, Van Riet C, Nguyen T, Simas C, Boey L, Kattumana T, Vandaele N, Larson HJ, Grietens KP, Giles-Vernick T, Gryseels C. Strategic silences, eroded trust: The impact of divergent COVID-19 vaccine sentiments on healthcare workers' relations with peers and patients. Vaccine 2023; 41:883-891. [PMID: 36319488 PMCID: PMC9606030 DOI: 10.1016/j.vaccine.2022.10.048] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Polarized debates about Covid-19 vaccination and vaccine mandates for healthcare workers (HCWs) challenge Belgian HCWs ability to discuss Covid-19 vaccine sentiments with peers and patients.Although studies have identified drivers of HCWs vaccine hesitancy, they do not include effects of workplace interactions and have not addressed consequences beyond vaccine coverage. METHODS Interviews and focus group discussions with 74 HCWs practicing in Belgium addressed Covid-19 vaccine sentiments and experiences of discussing vaccination with peers and patients. RESULTS Most participating HCWs reported difficulties discussing Covid-19 vaccination with peers and patients. Unvaccinated HCWs often feared that expressing their vaccine sentiments might upset patients or peers and that they would be suspended. Consequently, they used social cues to evaluate others' openness to vaccine-skeptical discourses and avoided discussing vaccines. Surprisingly, some vaccine-confident HCWs hid their vaccine sentiments to avoid peer and patient conflicts. Both vaccinated and unvaccinated HCWs observed that unvaccinated patients occasionally received suboptimal care. Suboptimal care was central in unvaccinated HCW unwillingness to express their vaccine sentiments to peers. Both vaccinated and unvaccinated HCWs described loss of trust and ruptured social relations with peers and patients holding divergent vaccine sentiments. DISCUSSION Belgian HCW perceived Covid-19 vaccines as a risky discussion topic and engaged in "strategic silences" around vaccination to maintain functional work relationships and employment in health institutions. Loss of trust between HCW and peers or patients, along with suboptimal patient care based on vaccination status, threaten to weaken Belgium's, and by implication, other health systems, and to catalyze preventable disease outbreaks.
Collapse
Affiliation(s)
- Leonardo W Heyerdahl
- Department of Global Health, Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France.
| | - Stef Dielen
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hélène Dodion
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - ToTran Nguyen
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Clarissa Simas
- Vaccine Confidence Project and London School of Hygiene and Tropical Medicine, United Kingdom
| | - Lise Boey
- Access-To-Medicines Research Centre, KU Leuven, Belgium
| | - Tarun Kattumana
- Access-To-Medicines Research Centre, KU Leuven, Belgium; Husserl Archives, Research Center for Phenomenology and Continental Philosophy, Institute of Philosophy, KU Leuven, Belgium
| | - Nico Vandaele
- Access-To-Medicines Research Centre, KU Leuven, Belgium
| | - Heidi J Larson
- Vaccine Confidence Project and London School of Hygiene and Tropical Medicine, United Kingdom
| | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Tamara Giles-Vernick
- Department of Global Health, Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
| | - Charlotte Gryseels
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
5
|
Decouttere C, Vandaele N, De Boeck K, Banzimana S. A Systems-Based Framework for Immunisation System Design: Six Loops, Three Flows, Two Paradigms. Health Syst (Basingstoke) 2023; 12:36-51. [PMID: 36926372 PMCID: PMC10013358 DOI: 10.1080/20476965.2021.1992300] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Despite massive progress in vaccine coverage globally, the region of sub-Saharan Africa is lagging behind for Sustainable Development Goal 3 by 2030. Sub-national under-immunisation is part of the problem. In order to reverse the current immunisation system's (IMS) underperformance, a conceptual model is proposed that captures the complexity of IMSs in low- and middle-income countries (LMICs) and offers directions for sustainable redesign. The IMS model was constructed based on literature and stakeholder interaction in Rwanda and Kenya. The model assembles the paradigms of planned and emergency immunisation in one system and emphasises the synchronised flows of vaccinee, vaccinator and vaccine. Six feedback loops capture the main mechanisms governing the system. Sustainability and resilience are assessed based on loop dominance and dependency on exogenous factors. The diagram invites stakeholders to share their mental models and. The framework provides a systems approach for problem structuring and policy design.
Collapse
Affiliation(s)
- Catherine Decouttere
- Centre for Access-To-Medicines (ATM) at Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nico Vandaele
- Centre for Access-To-Medicines (ATM) at Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kim De Boeck
- Centre for Access-To-Medicines (ATM) at Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stany Banzimana
- University of Rwanda, EAC Regional Centre of Excellence for Vaccines, Immunisation and Health Supply Chain Management, Kigali, Rwanda
| |
Collapse
|
6
|
Nguyen T, Boey L, Van Riet C, Dielen S, Dodion H, Giles-Vernick T, Vandaele N, Larson HJ, Peeters Grietens K, Gryseels C, Heyerdahl LW. Embracing context: Lessons from designing a dialogue-based intervention to address vaccine hesitancy. Front Public Health 2023; 11:1069199. [PMID: 36891336 PMCID: PMC9986323 DOI: 10.3389/fpubh.2023.1069199] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
Dialogue with people who are vaccine hesitant has been recommended as a method to increase vaccination uptake. The process of cultivating dialogue is shaped by the context in which it occurs, yet the development of interventions addressing vaccine hesitancy with dialogue often overlooks the role of context and favors relatively fixed solutions. This reflexive paper shares three key lessons related to context for dialogue-based interventions. These lessons emerged during a participatory research project to develop a pilot intervention to create open dialogue among healthcare workers in Belgium about COVID-19 vaccination concerns. Through a mixed methods study consisting of in-depth interviews, focus group discussions, and surveys, we engaged healthcare workers in the design, testing, and evaluation of a digital platform featuring text-based and video-based (face-to-face) interactions. The lessons are: (1) what dialogue means, entails, and requires can vary for a population and context, (2) inherent tension exists between helping participants voice (and overcome) their concerns and exposing them to others' ideas that may exacerbate those concerns, and (3) interactional exchanges (e.g., with peers or experts) that matter to participants may shape the dialogue in terms of its content and form. We suggest that having a discovery-orientation-meaning to work not only inductively and iteratively but also reflexively-is a necessary part of the development of dialogue-based interventions. Our case also sheds light on the influences between: dialogue topic/content, socio-political landscape, population, intervention aim, dialogue form, ethics, researcher position, and types of interactional exchanges.
Collapse
Affiliation(s)
- ToTran Nguyen
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Work and Organisation Studies, KU Leuven, Leuven, Belgium
| | - Lise Boey
- Access-To-Medicines Research Centre, KU Leuven, Leuven, Belgium
| | - Carla Van Riet
- Access-To-Medicines Research Centre, KU Leuven, Leuven, Belgium
| | - Stef Dielen
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hélène Dodion
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tamara Giles-Vernick
- Anthropology and Ecology of Disease Emergence Unit, Department of Global Health, Institut Pasteur, Paris, France
| | - Nico Vandaele
- Access-To-Medicines Research Centre, KU Leuven, Leuven, Belgium
| | - Heidi J Larson
- Vaccine Confidence Project, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Charlotte Gryseels
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Leonardo W Heyerdahl
- Anthropology and Ecology of Disease Emergence Unit, Department of Global Health, Institut Pasteur, Paris, France
| |
Collapse
|
7
|
Kiekens A, Bwire GM, Decouttere C, Jordan MR, Mangara A, Mosha IH, Rinke de Wit T, Sangeda RZ, Swalehe O, Vandaele N, Killewo J, Vandamme AM. HIV and SARS-CoV-2: the interplay of two wicked problems. BMJ Glob Health 2022; 7:bmjgh-2022-009105. [PMID: 35918073 PMCID: PMC9350738 DOI: 10.1136/bmjgh-2022-009105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anneleen Kiekens
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, Leuven, Belgium
| | - George Msema Bwire
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, Leuven, Belgium.,Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Catherine Decouttere
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, Leuven, Belgium
| | - Michael R Jordan
- Division of Geographic Medicine and Infectious Diseases, Tufts University School of Medicine, Boston, Massachusetts, USA.,Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ally Mangara
- Dar es Salaam Urban Cohort Study, Dar es Salaam, Tanzania, United Republic of
| | - Idda H Mosha
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Tobias Rinke de Wit
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
| | - Raphael Zozimus Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Omary Swalehe
- Department of Business Studies, Mzumbe University, Dar es Salaam, Tanzania, United Republic of
| | - Nico Vandaele
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, Leuven, Belgium
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, Leuven, Belgium .,Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| |
Collapse
|
8
|
Kiekens A, Dierckx de Casterlé B, Pellizzer G, Mosha IH, Mosha F, Rinke de Wit TF, Sangeda RZ, Surian A, Vandaele N, Vranken L, Killewo J, Jordan M, Vandamme AM. Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa: conceptual mapping of a complex adaptive system based on multi-disciplinary expert insights. BMC Public Health 2022; 22:455. [PMID: 35255842 PMCID: PMC8899794 DOI: 10.1186/s12889-022-12738-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/07/2020] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR are driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remains unclear and African policy makers encounter difficulties setting priorities combating HIVDR. By viewing HIVDR as a complex adaptive system, through the eyes of multi-disciplinary HIVDR experts, we aimed to make a first attempt to linking different influencing factors and gaining a deeper understanding of the complexity of the system. Methods We designed a detailed systems map of factors influencing HIVDR based on semi-structured interviews with 15 international HIVDR experts from or with experience in sub-Saharan Africa, from different disciplinary backgrounds and affiliated with different types of institutions. The resulting detailed system map was conceptualized into three main HIVDR feedback loops and further strengthened with literature evidence. Results Factors influencing HIVDR in sub-Saharan Africa and their interactions were sorted in five categories: biology, individual, social context, healthcare system and ‘overarching’. We identified three causal loops cross-cutting these layers, which relate to three interconnected subsystems of mechanisms influencing HIVDR. The ‘adherence motivation’ subsystem concerns the interplay of factors influencing people living with HIV to alternate between adherence and non-adherence. The ‘healthcare burden’ subsystem is a reinforcing loop leading to an increase in HIVDR at local population level. The ‘ART overreliance’ subsystem is a balancing feedback loop leading to complacency among program managers when there is overreliance on ART with a perceived low risk to drug resistance. The three subsystems are interconnected at different levels. Conclusions Interconnectedness of the three subsystems underlines the need to act on the entire system of factors surrounding HIVDR in sub-Saharan Africa in order to target interventions and to prevent unwanted effects on other parts of the system. The three theories that emerged while studying HIVDR as a complex adaptive system form a starting point for further qualitative and quantitative investigation. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12738-4.
Collapse
Affiliation(s)
- Anneleen Kiekens
- Department of Microbiology, Immunology and Transplantation, Clinical and Epidemiological Virology, Institute for the Future, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
| | | | | | - Idda H Mosha
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, P.O Box 65015, Dar es Salaam, Tanzania
| | - Fausta Mosha
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - Tobias F Rinke de Wit
- Amsterdam Instiute for Global Health and Development (AIGHD), Amsterdam, the Netherlands
| | - Raphael Z Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O Box 65012, Dar es Salaam, Tanzania
| | - Alessio Surian
- FISPPA Department, Università Degli Studi Di Padova, 35139, Padova, Italy
| | - Nico Vandaele
- Faculty of Economics and Business, Access To Medicine Research Center, KU Leuven, Leuven, Belgium
| | - Liesbet Vranken
- Department of Earth and Environmental Sciences, Division of Bioeconomics, KU Leuven, Leuven, Belgium
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Michael Jordan
- Tufts University School of Medicine, Boston, USA.,Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA.,Tufts Center for Tufts Center for Integrated Management of Antimicrobial Resistance (CIMAR), Boston, USA
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, Clinical and Epidemiological Virology, Institute for the Future, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.,Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene E Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
9
|
Heyerdahl LW, Dielen S, Nguyen T, Van Riet C, Kattumana T, Simas C, Vandaele N, Vandamme AM, Vandermeulen C, Giles-Vernick T, Larson H, Grietens KP, Gryseels C. Doubt at the core: Unspoken vaccine hesitancy among healthcare workers. Lancet Reg Health Eur 2021; 12:100289. [PMID: 34927116 PMCID: PMC8668386 DOI: 10.1016/j.lanepe.2021.100289] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Affiliation(s)
- Leonardo W Heyerdahl
- Department of Global Health, Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
| | - Stef Dielen
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - ToTran Nguyen
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Tarun Kattumana
- Access-To-Medicines Research Centre, KU Leuven, Belgium.,Husserl Archives, Research Center for Phenomenology and Continental Philosophy, Institute of Philosophy, KU Leuven, Belgium
| | - Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nico Vandaele
- Access-To-Medicines Research Centre, KU Leuven, Belgium
| | - Anne-Mieke Vandamme
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, Leuven, Belgium.,Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Corinne Vandermeulen
- Youth Health Care, Environment and Health Leuven University Vaccinology Centre KU Leuven, Belgium
| | - Tamara Giles-Vernick
- Department of Global Health, Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
| | - Heidi Larson
- Vaccine Confidence Project and London School of Hygiene and Tropical Medicine, United Kingdom
| | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Charlotte Gryseels
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
10
|
Kiekens A, Mosha IH, Zlatić L, Bwire GM, Mangara A, Dierckx de Casterlé B, Decouttere C, Vandaele N, Sangeda RZ, Swalehe O, Cottone P, Surian A, Killewo J, Vandamme AM. Factors Associated with HIV Drug Resistance in Dar es Salaam, Tanzania: Analysis of a Complex Adaptive System. Pathogens 2021; 10:1535. [PMID: 34959490 PMCID: PMC8707982 DOI: 10.3390/pathogens10121535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
HIV drug resistance (HIVDR) is a complex problem with multiple interconnected and context dependent causes. Although the factors influencing HIVDR are known and well-studied, HIVDR remains a threat to the effectiveness of antiretroviral therapy. To understand the complexity of HIVDR, a comprehensive, systems approach is needed. Therefore, a local systems map was developed integrating all reported factors influencing HIVDR in the Dar es Salaam Urban Cohort Study area in Tanzania. The map was designed based on semi-structured interviews and workshops with people living with HIV and local actors who encounter people living with HIV during their daily activities. We visualized the feedback loops driving HIVDR, compared the local map with a systems map for Sub-Saharan Africa, previously constructed from interviews with international HIVDR experts, and suggest potential interventions to prevent HIVDR. We found several interconnected balancing and reinforcing feedback loops related to poverty, stigmatization, status disclosure, self-esteem, knowledge about HIVDR and healthcare system workload, among others, and identified three potential leverage points. Insights from this local systems map were complementary to the insights from the Sub-Saharan systems map showing that both viewpoints are needed to fully understand the system. This study provides a strong baseline for quantitative modelling, and for the identification of context-dependent, complexity-informed leverage points.
Collapse
Affiliation(s)
- Anneleen Kiekens
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
| | - Idda H. Mosha
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65015, Tanzania;
| | - Lara Zlatić
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
- FISPPA Department, Università degli Studi di Padova, 35139 Padova, Italy; (P.C.); (A.S.)
| | - George M. Bwire
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65013, Tanzania;
| | - Ally Mangara
- Dar es Salaam Urban Cohort Study, Dar es Salaam 65013, Tanzania;
| | - Bernadette Dierckx de Casterlé
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, 3000 Leuven, Belgium;
| | - Catherine Decouttere
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000 Leuven, Belgium; (C.D.); (N.V.)
| | - Nico Vandaele
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000 Leuven, Belgium; (C.D.); (N.V.)
| | - Raphael Z. Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65013, Tanzania;
| | - Omary Swalehe
- Department of Business Studies, School of Business, Mzumbe University, Dar es Salaam 20266, Tanzania;
| | - Paolo Cottone
- FISPPA Department, Università degli Studi di Padova, 35139 Padova, Italy; (P.C.); (A.S.)
| | - Alessio Surian
- FISPPA Department, Università degli Studi di Padova, 35139 Padova, Italy; (P.C.); (A.S.)
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65001, Tanzania;
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
- Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal
| |
Collapse
|
11
|
Decouttere C, Banzimana S, Davidsen P, Van Riet C, Vandermeulen C, Mason E, Jalali MS, Vandaele N. Insights into vaccine hesitancy from systems thinking, Rwanda. Bull World Health Organ 2021; 99:783-794D. [PMID: 34737471 PMCID: PMC8542260 DOI: 10.2471/blt.20.285258] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. METHODS Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. FINDINGS A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. CONCLUSION The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified.
Collapse
Affiliation(s)
| | - Stany Banzimana
- East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, Rwanda
| | - Pål Davidsen
- System Dynamics Group, University of Bergen, Bergen, Norway
| | - Carla Van Riet
- Research Center for Access-to-Medicines, Naamsestraat 69, 3000 Leuven, Belgium
| | | | - Elizabeth Mason
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Cambridge, United States of America
| | - Mohammad S Jalali
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Cambridge, United States of America
| | - Nico Vandaele
- Research Center for Access-to-Medicines, Naamsestraat 69, 3000 Leuven, Belgium
| |
Collapse
|
12
|
Abstract
BACKGROUND Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 Sustainable Development Goals (SDGs), such as ending poverty, reducing hunger, and reducing inequalities. Therefore, immunization is recognized to play a central role in reaching the SDGs, especially in low- and middle-income countries (LMICs). Despite continuous interventions to strengthen immunization systems and to adequately respond to emergency immunization during epidemics, the immunization-related indicators for SDG3 lag behind in sub-Saharan Africa. Especially taking into account the current Covid19 pandemic, the current performance on the connected SDGs is both a cause and a result of this. METHODS We conduct a literature review through a keyword search strategy complemented with handpicking and snowballing from earlier reviews. After title and abstract screening, we conducted a qualitative analysis of key insights and categorized them according to showing the impact of immunization on SDGs, sustainability challenges, and model-based solutions to these challenges. RESULTS We reveal the leveraging mechanisms triggered by immunization and position them vis-à-vis the SDGs, within the framework of Public Health and Planetary Health. Several challenges for sustainable control of vaccine-preventable diseases are identified: access to immunization services, global vaccine availability to LMICs, context-dependent vaccine effectiveness, safe and affordable vaccines, local/regional vaccine production, public-private partnerships, and immunization capacity/capability building. Model-based approaches that support SDG-promoting interventions concerning immunization systems are analyzed in light of the strategic priorities of the Immunization Agenda 2030. CONCLUSIONS In general terms, it can be concluded that relevant future research requires (i) design for system resilience, (ii) transdisciplinary modeling, (iii) connecting interventions in immunization with SDG outcomes, (iv) designing interventions and their implementation simultaneously, (v) offering tailored solutions, and (vi) model coordination and integration of services and partnerships. The research and health community is called upon to join forces to activate existing knowledge, generate new insights and develop decision-supporting tools for Low-and Middle-Income Countries' health authorities and communities to leverage immunization in its transformational role toward successfully meeting the SDGs in 2030.
Collapse
Affiliation(s)
- Catherine Decouttere
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Kim De Boeck
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Nico Vandaele
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| |
Collapse
|
13
|
Stulens S, De Boeck K, Vandaele N. HIV supply chains in low- and middle-income countries: overview and research opportunities. JHLSCM 2021. [DOI: 10.1108/jhlscm-08-2020-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeDespite HIV being reported as one of the major global health issues, availability and accessibility of HIV services and supplies remain limited, especially in low- and middle-income countries. The effective and efficient operation of HIV supply chains is critical to tackle this problem. The purpose of this paper is to give an introduction to HIV supply chains in low- and middle-income countries and identify research opportunities for the operations research/operations management (OR/OM) community.Design/methodology/approachFirst, the authors review a combination of the scientific and grey literature, including both qualitative and quantitative papers, to give an overview of HIV supply chain operations in low- and middle-income countries and the challenges that are faced by organizing such supply chains. The authors then classify and discuss the relevant OR/OM literature based on seven classification criteria: decision level, methodology, type of HIV service modeled, challenges, performance measures, real-life applicability and countries covered. Because research on HIV supply chains in low- and middle-income countries is limited in the OR/OM field, this part also includes papers focusing on HIV supply chain modeling in high-income countries.FindingsThe authors conclude this study by identifying several tendencies and gaps and by proposing future research directions for OR/OM research.Originality/valueTo the best of the authors’ knowledge, this paper is the first literature review addressing this specific topic from an OR/OM perspective.
Collapse
|
14
|
Gutjahr WJ, Noyan N, Vandaele N, Van Wassenhove LN. Innovative approaches in humanitarian operations. OR Spectr 2020; 42:585-589. [PMID: 32836595 PMCID: PMC7382970 DOI: 10.1007/s00291-020-00598-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 05/31/2023]
Affiliation(s)
- Walter J. Gutjahr
- University of Vienna, Oskar-Morgenstern-Platz 1, 1090 Vienna, Austria
| | | | | | | |
Collapse
|
15
|
Lemmens S, Decouttere C, Vandaele N, Bernuzzi M. A review of integrated supply chain network design models: Key issues for vaccine supply chains. Chem Eng Res Des 2016. [DOI: 10.1016/j.cherd.2016.02.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
16
|
Vandaele N, Iwanicki-Caron I, Piat M, Hervé S, Ducrotté P. Translocation of an intra-uterine contraceptive device with sigmoid penetration through an endometriosic nodule. Gastroenterol Clin Biol 2009; 33:488-90. [PMID: 19428208 DOI: 10.1016/j.gcb.2009.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 03/06/2009] [Accepted: 03/09/2009] [Indexed: 11/28/2022]
Abstract
The intra-uterine device (IUD) is the most common existing reversible contraception. Uterine perforation occurs in 0.6 to 3.4 per 1000 insertions. We describe the first report of IUD translocation and subsequent penetration of the sigmoid through an endometriosic nodule. A 44-year-old gravida 2 para 2 woman consulted for rectal bleeding and melena. Rectosigmoidoscopy revealed ischemic colitis secondary to the use of NSAIDs, which explained the bleeding, but also sigmoid perforation from part of an intra-uterine device. This was discovered by chance. Perforation had occurred though an endometriosic nodule.
Collapse
Affiliation(s)
- N Vandaele
- Department of Gastroenterology, CHU de Rouen, 76000 Rouen, France
| | | | | | | | | |
Collapse
|