A commentary on establishing a local centre of excellence for
research and training in Pharmacometrics: Lessons from the
Pharmacometrics Africa -Uganda
C hapter.
Authors: Letisha Najjemba1, Aida
Nakayiwa Kawuma1, Francis Williams
Ojara1,5, Bonniface
Obura3,7Christine Sekaggya1,2,
Walter Arinaitwe1, Ruth Kikonyogo1,
Jackson Mukonzo8 , Goonaseelan (Colin)
Pillai3,6, Catriona Waitt1,4
- Infectious Diseases Institute, College of Health Sciences, Makerere
University, Kampala Uganda
- Department of Medicine, College of Health Sciences, Makerere
University, Kampala, Uganda
- CP+ Associates GmbH, Basel, Switzerland
- Department of Pharmacology and Therapeutics, University of Liverpool,
United Kingdom
- Department of Pharmacology and Therapeutics, Gulu University, Uganda
- Division of Clinical Pharmacology, University of Cape Town, Cape Town,
South Africa
- Department of Pharmacology and Therapeutics, Lira University, Uganda
- Department of Pharmacology and Therapeutics, College of Health
Sciences, Makerere University, Kampala, Uganda
Pharmacometrics, the mathematical approaches to describe the transfer of
drug through different biological compartments, are essential tools in
clinical pharmacology research. The ethical necessity to study drugs
accurately in the populations where they are to be used is increasingly
recognized. To maximise the value of clinical data, study design and
analysis must be appropriate. Historically, many datasets have been sent
from African countries to better-resourced settings for analysis, but in
recent years it has been demonstrated that capacity can be built and
sustained within low and middle-income countries
(LMIC)3. We report the establishment of the Uganda
Chapter of Pharmacometrics Africa, to share learning with other
countries seeking to build similar capabilities.
Current pharmacometric approaches require computational power,
appropriate software and knowledge of the mathematical principles and
assumptions underpinning the techniques. Between 2012 and 2016,
academic-industry collaborations were established between Makerere
University and several US pharmacometricians; this principally comprised
the delivery of workshops in Uganda. Recognising the need to both build
and sustain capacity in these skills across the continent,
Pharmacometrics Africa
(www.pmxafrica.org) was launched in
2018, to develop quantitative clinical pharmacology among African
scientists, and more generally among pharmacometricians in LMIC. They
provide online training courses, hands-on workshops, mentorship and
supervision of scientists conducting projects that use quantitative
methods addressing locally relevant healthcare questions. All training
materials from Pharmacometrics Africa are provided under Creative
Commons license arrangements.
The Infectious Diseases Institute (IDI), Makerere University was
established in 2002 in
Kampala, Uganda by the Academic Alliance for AIDS Care and Prevention in
Africa. The IDI has since built international strength in clinical
research surrounding the treatment of infectious diseases in Africa.
Despite the growing awareness of pharmacometrics as a discipline, and
increasing numbers of individuals possessing basic and intermediate
skills, until about 2016 almost all pharmacokinetic data generated
within Uganda was exported to collaborative partners for analysis. This
was necessary because, despite an increasing number of individuals
having undergone training in the techniques, there was not yet a
functional group of pharmacometricians capable of undertaking complex
analyses with confidence.
From 2019, Pharmacometrics Africa expanded from local in-person
trainings to host online introductory courses on pharmacology and
pharmacometrics.
In parallel, IDI established expertise in online teaching and training
(https://elearning.idi.co.ug/) using the Moodle platform, for a
variety of clinical topics. Despite hosting the Pharmacometrics
Africa online courses between 2019 and 2021 there was a heavy reliance
on international tutors. However, an increasing number of Ugandan
researchers had accessed training and mentorship through Pharmacometrics
Africa and continued to work within the discipline to the point where
there was a ‘critical mass’ of skill within Uganda. Therefore in 2021 we
officially launched the Ugandan Chapter of Pharmacometrics Africa, with
the aim to:
- Transfer primary training
responsibility to local faculty for sustainability.
- Build upon regional strengths in pharmacometrics to establish a local
centre of excellence.
- Attract increasing collaborations on quantitative clinical
pharmacology projects.
- Enhance the credibility of pharmacometrics in research, regulatory and
clinical practice among Ugandan stakeholders.
In line with the first aim of the chapter, from September to December
2021 Uganda hosted the first clinical pharmacology course led by an
all-Uganda team of tutors. Preparation involved consolidating the team
of tutors, allocating roles and reviewing existing course content. Since
previous iterations of the 12-week online pharmacometrics course had
been hosted by IDI, it was relatively straightforward for the team to
update these resources for a subsequent, locally led iteration.
Whilst the online course was to be the first specific activity of the
Uganda Chapter, the process of team building, content review and
consideration of teaching skills and styles also provided the
opportunity to launch the Uganda Community of Practice in
Pharmacometrics. Throughout this process, senior members of the
Pharmacometrics Africa team (Colin Pillai, Paolo Denti and Leon Aarons)
provided mentorship and ‘train the trainers’ style coaching.
The course was advertised among our networks, mailing lists and via
social media to reach potentially eligible individuals. Candidates were
required to show a background of proven numerical ability and planned
use of pharmacometrics in their work. Priority was given to those from
within Africa, although international applications were welcomed. A
version of this course is available on the pharmacometrics Africa
website (www.pmxafrica.org)
We received 247 applications and invited 42 candidates to participate.
18 (43%) participants were from Uganda, seven from Nigeria, two from
Brazil and India, three from Tanzania and South Africa and one each from
Kuwait and Sierra Leonne. Their fields included biochemistry, biological
sciences, biotechnology, clinical epidemiology and public health,
laboratory medicine, medicine, pharmacology, mathematics, midwifery and
pharmacy. The course was facilitated by seven Ugandan faculty members
and four guest tutors who are all Africans with previous Pharmacometrics
Africa experience.
Of the 42 invited candidates, five did not start. Consequently, the
course was attended by 37 participants from eight countries. Of the 37
participants, a further five withdrew during the course primarily due to
competing demands on their time, six did complete the course due to
failure to complete the course tasks and 26 (71%) met the criteria for
the award of a certificate of completion. The criteria for completion
included completion of at least 70% of the tasks, consistently logging
onto the online learning platform and engagement in discussions. To
enhance participants’ engagement, participants were grouped into groups
of about five, each with a mentor (one of the tutors) who offered
guidance weekly. The assessment focused on identifying potential and
interest in the discipline rather than on achieving a specific grade.
Participants were granted extra time to complete tasks and engage with
course materials. We adapted the course programme to include an
additional ‘consolidation week’ between weeks 9 and 10 to enable
participants to catch up and spend time working on the practical
exercises with support from the tutors. Weekly feedback was almost
universally positive, but the biggest area of concern reported by the
students was the time required to complete the self-study materials and
truly engage with the hands-on exercises.
Although the need for universities in LMIC to develop graduate-level
pharmacometrics programs has been well demonstrated, many may be
reluctant to invest the time and money required to hire experts in the
field as faculty and to support them until external funding can be
established. It is our opinion that donors and funders could help a
great deal in this area by providing funds for faculty and staff, as
well as lending schools the expertise of industrial scientists. Through
such efforts, pharmacometrics can indeed mature and grow as a scientific
discipline on the African continent.
In the year since the inception of the Uganda Chapter, several
priorities to increase pharmacometrics research in Uganda have been
established, as summarized in Table 1.
Table 1