scholarly journals Treatment of Chronic Myeloid Leukemia in Rural Rwanda: Promising Early Outcomes

2016 ◽  
Vol 2 (3) ◽  
pp. 129-137 ◽  
Author(s):  
Neo Tapela ◽  
Ignace Nzayisenga ◽  
Roshan Sethi ◽  
Jean Bosco Bigirimana ◽  
Hamissy Habineza ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Rural Setting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Included Patient ◽  
District Hospitals ◽  
Diagnostic Work ◽  
Low And Middle Income

Purpose The burden of cancer is rising in low- and middle-income countries, yet cancer treatment requires resources that are often not available in these settings. Although management of chronic myeloid leukemia (CML) has been described in low- and middle-income countries, few programs involve patients treated in rural settings. We describe characteristics and early outcomes of patients treated for CML at rural district hospitals in Rwanda. Methods We conducted a retrospective review of patients with confirmed BCR-ABL–positive CML who were enrolled between July 1, 2009 and June 30, 2014. Types of data included patient demographics, diagnostic work up, treatment, clinical examination, laboratory testing, and death. Results Forty-three patients were included, with a maximum follow-up of 58 months. Of 31 patients who were imatinib-naïve at enrollment, 54.8% were men and the median age at diagnosis was 36.9 years (interquartile range: 29-42 years). Approximately two-thirds of patients (67.7%) were on the national public insurance scheme. The imatinib dose was reduced for 16 patients and discontinued for five. Thirty-two of the 43 patients continued to have normal blood counts at last follow-up. Four patients have died and four are lost to follow-up. Conclusion Our experience indicates that CML can be effectively managed in a resource-constrained rural setting, despite limited availability of on-site diagnostic resources or specialty oncology personnel. The importance of model public-private partnerships as a strategy to bring high-cost, life-saving treatment to people who do not have the ability to pay is also highlighted.

scholarly journals Analysis of the Gap in PCR Monitoring Availability for Patients with Chronic Myeloid Leukemia in 60 Low- and Middle-Income Countries

2020 ◽  
Author(s):  
Seth Rowley ◽  
Patricia Garcia-Gonzalez ◽  
Jerald P Radich ◽  
Irina Usherenko ◽  
Joseph B Babigumira
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Labor Costs ◽  
Middle Income ◽  
Demand And Supply ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Resource Needs ◽  
Low And Middle Income

Abstract Purpose: To estimate the resource gap in the polymerase chain reaction (PCR) monitoring for patients with chronic myeloid leukemia (CML) in low- and middle-income countries (LMICs). Methods: We developed a model of demand and supply of PCR monitoring of CML patients in 60 LMICs. PCR testing was assumed to use Cepheid’s GeneXpert® IV system. We included costs of GeneXpert® instruments, uninterrupted power supplies, warranties, calibration kits, test cartridges, and shipping. We calculated the country-specific monetary gap in PCR monitoring, stratified by country priority defined as the availability of tyrosine kinase inhibitors (TKIs) through The Max Foundation initiatives. Results: The five-year gap in PCR monitoring was $29.1 million across all countries, 22% ($6.4 million) in countries with all five TKIs available, 20% ($5.7 million) in countries with four TKIs available, 50% ($14.5 million) in countries with three TKIs available, 8% ($2.2 million) in countries with two TKIs available, and 1% ($0.3 million) in countries with one TKI available. The gap was highest in South Asia (52%; $15.1 million) and lowest in Latin America (6%; $1.9 million). Excluding labor costs, the bulk of the resource needs (86%; $25.2 million) were for procurement of BCR-ABL cartridges. Conclusion: Removing the five-year gap in PCR monitoring capacity for CML in LMICs will require the mobilization of significant resources and will likely lead to better treatment outcomes and reduced treatment costs through optimization of treatment, discontinuation of therapy in appropriate patients, and facilitation of clinical research. Development of streamlined monitoring guidelines for resource-limited countries should be considered.

scholarly journals Analysis of the gap in PCR monitoring availability for patients with chronic myeloid leukemia in 60 low- and middle-income countries

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Seth Rowley ◽  
Pat Garcia-Gonzalez ◽  
Jerald P. Radich ◽  
Ann Kim Novakowski ◽  
Irina Usherenko ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Labor Costs ◽  
Middle Income ◽  
Demand And Supply ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Resource Needs ◽  
Low And Middle Income

Abstract Purpose To estimate the resource gap in the polymerase chain reaction (PCR) monitoring for patients with chronic myeloid leukemia (CML) in low- and middle-income countries (LMICs). Methods We developed a model of demand and supply of PCR monitoring of CML patients in 60 LMICs. PCR testing was assumed to use Cepheid’s GeneXpert® IV system. We included costs of GeneXpert® instruments, uninterrupted power supplies, warranties, calibration kits, test cartridges, and shipping. We calculated the country-specific monetary gap in PCR monitoring, stratified by country priority defined as the availability of tyrosine kinase inhibitors (TKIs) through The Max Foundation initiatives. Results The 5-year gap in PCR monitoring was $29.1 million across all countries, 22% ($6.4 million) in countries with all five TKIs available, 20% ($5.7 million) in countries with four TKIs available, 50% ($14.5 million) in countries with three TKIs available, 8% ($2.2 million) in countries with two TKIs available, and 1% ($0.3 million) in countries with one TKI available. The gap was highest in South Asia (52%; $15.1 million) and lowest in Latin America (6%; $1.9 million). Excluding labor costs, the bulk of the resource needs (86%; $25.2 million) were for procurement of BCR-ABL cartridges. Conclusion Removing the 5-year gap in PCR monitoring capacity for CML in LMICs will require the mobilization of significant resources and will likely lead to better treatment outcomes and reduced treatment costs through optimization of treatment, discontinuation of therapy in appropriate patients, and facilitation of clinical research. Development of streamlined monitoring guidelines for resource-limited countries should be considered.

scholarly journals Analysis of the Gap in PCR Monitoring Availability for Patients with Chronic Myeloid Leukemia in 60 Low- and Middle-Income Countries

2021 ◽  
Author(s):  
Seth Rowley ◽  
Patricia Garcia-Gonzalez ◽  
Jerald P Radich ◽  
Irina Usherenko ◽  
Joseph B Babigumira
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Labor Costs ◽  
Middle Income ◽  
Demand And Supply ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Resource Needs ◽  
Low And Middle Income

Abstract Purpose: To estimate the resource gap in the polymerase chain reaction (PCR) monitoring for patients with chronic myeloid leukemia (CML) in low- and middle-income countries (LMICs). Methods: We developed a model of demand and supply of PCR monitoring of CML patients in 60 LMICs. PCR testing was assumed to use Cepheid’s GeneXpert® IV system. We included costs of GeneXpert® instruments, uninterrupted power supplies, warranties, calibration kits, test cartridges, and shipping. We calculated the country-specific monetary gap in PCR monitoring, stratified by country priority defined as the availability of tyrosine kinase inhibitors (TKIs) through The Max Foundation initiatives. Results: The five-year gap in PCR monitoring was $29.1 million across all countries, 22% ($6.4 million) in countries with all five TKIs available, 20% ($5.7 million) in countries with four TKIs available, 50% ($14.5 million) in countries with three TKIs available, 8% ($2.2 million) in countries with two TKIs available, and 1% ($0.3 million) in countries with one TKI available. The gap was highest in South Asia (52%; $15.1 million) and lowest in Latin America (6%; $1.9 million). Excluding labor costs, the bulk of the resource needs (86%; $25.2 million) were for procurement of BCR-ABL cartridges. Conclusion: Removing the five-year gap in PCR monitoring capacity for CML in LMICs will require the mobilization of significant resources and will likely lead to better treatment outcomes and reduced treatment costs through optimization of treatment, discontinuation of therapy in appropriate patients, and facilitation of clinical research. Development of streamlined monitoring guidelines for resource-limited countries should be considered.

scholarly journals Analysis of the Gap in PCR Monitoring Availability for Patients with Chronic Myeloid Leukemia in 60 Low- and Middle-Income Countries

2020 ◽  
Author(s):  
Seth Rowley ◽  
Patricia Garcia-Gonzalez ◽  
Jerald P Radich ◽  
Irina Usherenko ◽  
Joseph B Babigumira
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Labor Costs ◽  
Middle Income ◽  
Demand And Supply ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Resource Needs ◽  
Low And Middle Income

Abstract Purpose: To estimate the resource gap in the polymerase chain reaction (PCR) monitoring for patients with chronic myeloid leukemia (CML) in low- and middle-income countries (LMICs). Methods: We developed a model of demand and supply of PCR monitoring of CML patients in 60 LMICs. PCR testing was assumed to use Cepheid’s GeneXpert® IV system. We included costs of GeneXpert® instruments, uninterrupted power supplies, warranties, calibration kits, test cartridges, and shipping. We calculated the country-specific monetary gap in PCR monitoring, stratified by country priority defined as the availability of tyrosine kinase inhibitors (TKIs) through The Max Foundation initiatives. Results: The five-year gap in PCR monitoring was $29.1 million across all countries, 22% ($6.4 million) in countries with all five TKIs available, 20% ($5.7 million) in countries with four TKIs available, 50% ($14.5 million) in countries with three TKIs available, 8% ($2.2 million) in countries with two TKIs available, and 1% ($0.3 million) in countries with one TKI available. The gap was highest in South Asia (52%; $15.1 million) and lowest in Latin America (6%; $1.9 million). Excluding labor costs, the bulk of the resource needs (86%; $25.2 million) were for procurement of BCR-ABL cartridges. Conclusion: Removing the five-year gap in PCR monitoring capacity for CML in LMICs will require the mobilization of significant resources and will likely lead to better treatment outcomes and reduced treatment costs through optimization of treatment, discontinuation of therapy in appropriate patients, and facilitation of clinical research. Development of streamlined monitoring guidelines for resource-limited countries should be considered.

scholarly journals SOCIAL AND FINANCIAL BARRIERS TO OPTIMUM TKI TREATMENT IN PATIENTS WITH CHRONIC MYELOID LEUKEMIA- A KNOWLEDGE-ATTITUDES-PRACTICES STUDY FROM INDIA

2020 ◽  
Vol 13 (1) ◽  
pp. e2021004
Author(s):  
Naveen Gupta ◽  
Manoranjan Mahapatra ◽  
Tulika Seth ◽  
Seema Tyagi ◽  
Sudha Sazawal ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Chronic Phase ◽  
Hospital Visit ◽  
Cost Of Treatment ◽  
Indian States ◽  
Financial Barriers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Introduction: Outcomes in chronic myeloid leukemia (CML) have vastly improved after the introduction of tyrosine kinase inhibitors. However, patients in low and middle income countries face many challenges due to social and financial barriers. Objective: This study was conducted with the aim of understanding socio-economic hindrances and knowledge-attitudes-practices of patients of chronic phase CML who are taking imatinib. Materials and Methods: Patients of chronic phase CML, aged 15 and above, taking imatinib for 6 months or more were included in the study. A questionnaire (in Hindi language) was administered, enquiring about perceptions of nature of disease and its treatment, how imatinib was obtained, drug-taking behaviour, economic and social burden of the treatment. Results: Four hundred patients were recruited (median age 37 years, median duration on imatinib 63 months). Patients hailed from 16 different Indian states and 29.75% patients had to travel more than 500 kilometres for their hospital visit. Scheduled visits were missed by 14.75%. One third of the patients were unaware of the lifelong duration of treatment and 41.75% were unaware of the risks of discontinuing treatment. Treatment was financed by three different means- 61.75% received imatinib free of cost via the Glivec International Patient Assistance Program (GIPAP), 14.25% had treatment costs reimbursed by their employer, and 24% bore the cost of treatment themselves. Patients felt financially burdened due to cost of drugs (self-paying patients), cost of investigations, expenditure of the commute and stay for hospital visit, and loss of working days due to hospital visits. Conclusion: Cost of treatment, lack of widespread availability of hematology services and poor patient awareness are significant barriers to optimum treatment of CML in low and middle income countries.

scholarly journals Using Telemedicine to Diagnose Surgical Site Infections in Low- and Middle-Income Countries: Systematic Review

10.2196/13309 ◽  
2019 ◽  
Vol 7 (8) ◽  
pp. e13309 ◽  
Author(s):  
Charlotte E J Sandberg ◽  
Stephen R Knight ◽  
Ahmad Uzair Qureshi ◽  
Samir Pathak
Keyword(s):  
English Language ◽  
Surgical Site Infections ◽  
Cochrane Central Register ◽  
Remote Diagnosis ◽  
Middle Income ◽  
High Loss ◽  
Mobile Phone Technology ◽  
Middle Income Countries ◽  
Low And Middle Income

Background A high burden of preventable morbidity and mortality due to surgical site infections (SSIs) occurs in low- and middle-income countries (LMICs), and most of these SSIs occur following discharge. There is a high loss to follow-up due to a wide geographical spread of patients, and cost of travel can result in delayed and missed diagnoses. Objective This review analyzes the literature surrounding the use of telemedicine and assesses the feasibility of using mobile phone technology to both diagnose SSIs remotely in LMICs and to overcome social barriers. Methods A literature search was performed using Medline, Embase, CINAHL, PubMed, Web of Science, the Cochrane Central Register of Controlled Trials and Google Scholar. Included were English language papers reporting the use of telemedicine for detecting SSIs in comparison to the current practice of direct clinical diagnosis. Papers were excluded if infections were not due to surgical wounds, or if SSIs were not validated with in-person diagnosis. The primary outcome of this review was to review the feasibility of telemedicine for remote SSI detection. Results A total of 404 articles were screened and three studies were identified that reported on 2082 patients across three countries. All studies assessed the accuracy of remote diagnosis of SSIs using predetermined telephone questionnaires. In total, 44 SSIs were accurately detected using telemedicine and an additional 14 were picked up on clinical follow-up. Conclusions The use of telemedicine has shown to be a feasible method in remote diagnosis of SSIs. Telemedicine is a useful adjunct for clinical practice in LMICs to decrease loss to postsurgical follow-up.

scholarly journals 407 - Living through the pandemic as an older person: Long-term psychological impacts in low- and middle-income countries

2021 ◽  
Vol 33 (S1) ◽  
pp. 33-33
Author(s):  
Clarissa Giebel ◽  
Bwire Ivan ◽  
Maria Isabel Zuluaga ◽  
Suresh Kumar ◽  
Mark Gabbay ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Well Being ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health And Social Care ◽  
The Impact ◽  
Low And Middle Income

Background:The pandemic has put a huge strain on people’s mental health, with varying restrictions affecting people’s lives. Little is known how the pandemic affects older adults’ mental health, particularly those living in low- and middle-income countries (LMICs) where restrictions are affecting people’s access to basic necessities. Thus, the aim of this 3-country study was to understand the long- term impacts of the pandemic on the mental well-being of older adults with and without dementia in LMICs.Methods:We are collecting 30 baseline and 15 follow-up interviews with older adults (aged 60+), people with dementia, and family carers in Colombia, India, and Uganda, as well as a baseline and follow-up focus group with health and social are professionals in each country. Interviews are conducted remotely over the phone due to pandemic restrictions, with data collection taking place between March and July 2021. Transcripts are translated into English before being analysed using thematic analysis.Results:To date, we have completed close to 90 baseline interviews and 3 focus groups with health and social care professionals. Analysis is ongoing, but findings are capturing the detrimental second wave in India and follow-up interviews will capture the longitudinal impacts on mental health.Conclusions:Whilst vaccines are starting to be rolled out in LMICs, albeit at different rates, the virus will likely take much longer to be somewhat managed in LMICs. This leaves more room for people’s physical as well as mental health to be impacted by the restrictions, and with often limited mental health service coverage, it is all the more important o understand the impact of the pandemic on older people’s mental health.

scholarly journals Results of Cancer Control Education for Primary Care Providers in Low- and Middle-Income Countries

2017 ◽  
Vol 3 (2_suppl) ◽  
pp. 18s-18s
Author(s):  
Vanessa J. Eaton ◽  
Megan K. Kremzier ◽  
Doug Pyle
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Cancer Control ◽  
Primary Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Health ◽  
Care Course ◽  
Low And Middle Income

Abstract 28 Background: The global burden of cancer is growing in low- and middle-income countries where availability of specialists to treat cancer is acutely low. To detect cancer earlier, patients must be educated about their risk for cancer and be screened when appropriate. In response to a growing need for cancer education in primary health care, ASCO International created the Cancer Control in Primary Care course, which was piloted in 2015. The purpose of the program is to increase the knowledge of primary health workers so as to recognize signs and symptoms of cancer, increase their ability to talk with patients about their risk, and to know how and when to refer patients for additional screening or diagnostic testing. Methods: ASCO collects data from participants in two stages: an on-site evaluation and a follow-up survey 12 months after the workshop. The survey instruments include questions about practice changes, learning objectives, and demographic information. Results: Follow-up surveys have been conducted for four courses. Ninety-three percent of respondents have reported that they made practice changes after the course. In addition, 90% reported that communication with patients about their risk for cancer had increased, 76% reported that they are screening patients for cancer more than before, and 74% reported that they have worked with specialists to plan treatment for their patients with cancer. Conclusion: Results of the Cancer Control in Primary Care course are positive, and ASCO will continue to collaborate with society and institutional partners to train primary health workers around the world to raise awareness of cancer. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

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