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In Western Kenya, the burden of chronic wounds and lymphedema has a significant impact on functionality and quality of life. Major barriers to provision of care include availability, affordability, and accessibility of bandages. At the Academic Model Providing Access to Healthcare, dermatologists and pharmacists collaborated to develop a 2-component compression bandage modeled after the Unna boot, using locally available materials, that is distributed through a revolving fund pharmacy network. In partnership with nursing, use of these bandages at a national referral hospital and a few county facilities has increased, but increasing utilization to an expanded catchment area is needed.

BackgroundHIV-associated Kaposi sarcoma (KS), among the most frequent cancers seen in sub-Saharan Africa, is associated with a high prevalence of lymphedema. Lymphedema causes progressive functional impairment marked by swelling, physical discomfort, disfiguring changes, skin hardening from fibrosis, poor wound healing, and recurrent skin infection. While compression therapy is considered a major component of lymphedema management, this intervention has never been evaluated in HIV-associated KS lymphedema.Methods/designThe Kenyan Improvised Compression for Kaposi Sarcoma (KICKS) study is a randomized, controlled trial. Due to variable lymphedema stage, we will use block randomization with a 1:1 allocation to assign participants to one of two groups: "Immediate compression" or "Delayed compression." Those randomized to "Immediate compression" intervention arm will receive weekly two-component compression bandages while receiving chemotherapy, whereas those in the "Delayed compression" control arm will be followed during chemotherapy and then receive compression after chemotherapy is completed. The primary outcome is change in Lower Extremity Lymphedema Index from enrollment at Week 0 to blinded outcome assessment at Week 14 between intervention and control arms. Secondary outcomes are change in leg lymphedema-specific quality of life (LYMQOL) and change in overall health quality of life in cancer (EORTC QLQ C30).DiscussionThis represents the first study in sub-Saharan Africa to assess a lymphedema-directed intervention for KS, and the intervention-locally sourced two-component compression bandages-is affordable and available. Thus, the KICKS study is an important step towards developing an evidence-based path for regionally relevant management of HIV-associated KS lymphedema.Trial registrationThis trial was registered at ClinicalTrials.gov on January 19, 2018: identifier NCT03404297.

IntroductionCompression therapy is well-established standard of care for chronic leg ulcers from venous disease and lymphedema. Chronic leg ulcers and lymphedema have a significant impact on quality of life, driven by pain, foul odor, and restricted mobility. Provision of layered compression therapy in resource-limited settings, as in Western Kenya and other regions of sub-Saharan Africa, is a major challenge due to several barriers: availability, affordability, and access to healthcare facilities. When wound care providers from an Academic Model Providing Access to Healthcare (AMPATH) health center in Western Kenya noted that a donated, finite supply of two-component compression bandages was helping to heal chronic leg ulcers, they began to explore the potential of finding a local, sustainable solution. Dermatology and pharmacy teams from AMPATH collaborated with health center providers to address this need.MethodsFollowing a literature review and examination of ingredients in prepackaged brand-name kits, essential components were identified: elastic crepe, gauze, and zinc oxide paste. All of these materials are locally available and routinely used for wound care. Two-component compression bandages were made by applying zinc oxide to dry gauze for the inner layer and using elastic crepe as the outer layer. Feedback from wound clinic providers was utilized to optimize the compression bandages for ease of use.ResultsAdjustments to assembly of the paste bandage included use of zinc oxide paste instead of zinc oxide ointment for easier gauze impregnation and cutting the inner layer gauze in half lengthwise to facilitate easier bandaging of the leg, such that there were two rolls of zinc-impregnated gauze each measuring 5 inches × 2 m. Adjustments to use of the compression bandage have included increasing the frequency of bandage changes from 7 to 3 days during the rainy seasons, when it is difficult to keep the bandage dry. Continuous local acquisition of all components led to lower price quotes for bulk materials, driving down the production cost and enabling a cost to the patient of 200 KSh (2 USD) per two-component compression bandage kit. Wound care providers have provided anecdotal reports of healed chronic leg ulcers (from venous stasis, trauma), improved lymphedema, and patient tolerance of compression.ConclusionsLow-cost locally sourced two-component compression bandages have been developed for use in Western Kenya. Their use has been initiated at an AMPATH health center and is poised to meet the need for affordable compression therapy options in Western Kenya. Studies evaluating their efficacy in chronic leg ulcers and Kaposi sarcoma lymphedema are ongoing. Future work should address adaptation of compression bandages for optimal use in Western Kenya and evaluate reproducibility of these bandages in similar settings, as well as consider home- or community-based care delivery models to mitigate transportation costs associated with accessing healthcare facilities.

Problem The coronavirus disease 2019 (COVID-19) pandemic has disrupted health systems worldwide and threatened the supply of essential medicines. Especially affected are vulnerable patients in low- and middle-income countries who can only afford access to public health systems. Approach Soon after physical distancing and curfew orders began on 15 March 2020 in Kenya, we rapidly implemented three supply-chain strategies to ensure a continuous supply of essential medicines while minimizing patients' COVID-19 exposure risks. We redistributed central stocks of medicines to peripheral health facilities to ensure local availability for several months. We equipped smaller, remote health facilities with medicine tackle boxes. We also made deliveries of medicines to patients with difficulty reaching facilities. Local setting To implement these strategies we leveraged our 30-year partnership with local health authorities in rural western Kenya and the existing revolving fund pharmacy scheme serving 85 peripheral health centres. Relevant changes In April 2020, stocks of essential chronic and non-chronic disease medicines redistributed to peripheral health facilities increased to 835 140 units, as compared with 316 330 units in April 2019. We provided medicine tackle boxes to an additional 46 health facilities. Our team successfully delivered medications to 264 out of 311 patients (84.9%) with noncommunicable diseases whom we were able to reach. Lessons learnt Our revolving fund pharmacy model has ensured that patients' access to essential medicines has not been interrupted during the pandemic. Success was built on a community approach to extend pharmaceutical services, adapting our current supply-chain infrastructure and working quickly in partnership with local health authorities. Probleme La pandemie de maladie a Coronavirus 2019 (COVID-19) a bouleverse les systemes de sante du monde entier et menace l'approvisionnement en medicaments essentiels. Dans les pays a faible et moyen revenu, les patients vulnerables ayant uniquement acces aux soins de sante publics ont ete particulierement affectes. Approche Peu apres l'instauration de la distanciation physique et du couvre-feu le 15 mars 2020 au Kenya, nous avons rapidement mis en oeuvre trois strategies visant a assurer un approvisionnement continu en medicaments essentiels, tout en limitant les risques d'exposition des patients au coronavirus. Nous avons redistribue les principaux stocks de medicaments aux etablissements sanitaires peripheriques afin de garantir leur disponibilite pendant plusieurs mois. Nous avons fourni des boites de materiel medical aux petits centres de soins implantes dans des regions reculees. Nous avons egalement livre des medicaments aux patients incapables de se rendre dans un etablissement. Environnement local Pour deployer ces strategies, nous avons profite de nos trente annees de partenariat avec les autorites sanitaires locales dans les regions rurales du Kenya occidental et compte sur le modele existant de financement pharmaceutique renouvelable, qui dessert 85 centres de soins peripheriques. Changements significatifs Les stocks de medicaments essentiels servant au traitement de maladies chroniques et non chroniques redistribues aux centres de soins peripheriques sont passes de 316 330 unites en avril 2019 a 835 140 unites en avril 2020. Nous avons procure des boites de materiel medical a 46 centres de soins supplementaires. Notre equipe a reussi a livrer des medicaments a 264 des 311 patients (84,9%) souffrant de maladies non transmissibles que nous sommes parvenus a contacter. Lecons tirees Grace a notre modele de financement pharmaceutique renouvelable, les patients ont pu acceder aux medicaments essentiels sans interruption durant la pandemie. Ce succes repose sur une approche communautaire destinee a etendre les services pharmaceutiques en adaptant l'infrastructure de notre chaine d'approvisionnement actuelle, et en avancant rapidement par le biais de partenariats avec les autorites sanitaires locales. Situacion La pandemia de la enfermedad por Coronavirus 2019 (COVID-19)ha perturbado los sistemas sanitarios de todo el mundo y ha amenazado el suministro de medicamentos esenciales. Se ven especialmente afectados los pacientes vulnerables de los paises de ingresos bajos y medios que solo pueden acceder a los sistemas sanitarios publicos. Enfoque Poco despues de que comenzaran el distanciamiento fisico y las ordenes de toque de queda el 15 de marzo de 2020 en Kenia, pusimos en marcha rapidamente tres estrategias para garantizar un suministro continuo de medicamentos esenciales y minimizar al mismo tiempo los riesgos de exposicion de los pacientes al COVID-19. Redistribuimos las existencias centrales de medicamentos a los centros de salud perifericos para garantizar la disponibilidad local durante varios meses. Equipamos a los centros de salud mas pequenos y remotos con cajas de botiquin. Tambien hicimos entregas de medicamentos a pacientes con dificultades para llegar a los centros. Marco regional Para poner en practica estas estrategias, hemos aprovechado nuestra asociacion de 30 anos con las autoridades sanitarias locales de las zonas rurales del oeste de Kenia y nos hemos apoyado en el modelo existente de financiacion farmaceutica rotatoria, que atiende a 85 centros de salud perifericos. Cambios importantes Las existencias de medicamentos esenciales para el tratamiento de enfermedades cronicas y no cronicas redistribuidas a los centros de atencion periferica pasaron de 316.330 unidades en abril de 2019 a 835.140 unidades en abril de 2020. Hemos adquirido cajas de material medico para otros 46 centros de salud. Nuestro equipo pudo entregar medicamentos a 264 de los 311 pacientes (84,9%) con enfermedades no transmisibles con los que logramos contactar. Lecciones aprendidas Gracias a nuestro modelo de financiacion farmaceutica rotatoria, los pacientes pudieron acceder a los medicamentos esenciales sin interrupcion durante la pandemia. Este exito se basa en un enfoque comunitario para ampliar los servicios farmaceuticos adaptando nuestra infraestructura de cadena de suministro existente y avanzando rapidamente mediante asociaciones con las autoridades sanitarias locales., Introduction The Coronavirus disease 2019 (COVID-19) pandemic has challenged health systems worldwide as they cope with the demands of infection control and management of the disease while maintaining the delivery [...]

Introduction: Like many countries in sub-Saharan Africa, Kenya is experiencing a rapid rise in the burden of non-communicable diseases (NCDs): NCDs now contribute to over 50% of inpatient admissions and 40% of hospital deaths in the country. The Academic Model Providing Access to Healthcare (AMPATH) Chronic Disease Management (CDM) programme builds on lessons and capacity of HIV care to deliver chronic NCD care layered into both HIV and primary care platforms to over 24,000 patients across 69 health facilities in western Kenya. We conducted a cost and budget impact analysis of scaling up the AMPATH CDM programme in western Kenya using the International Society for Pharmacoeconomics and Outcomes Research guidelines. Methods: Costs of the CDM programme for the health system were measured retrospectively for 69 AMPATH clinics from 2014 to 2018 using programmatic records and clinic schedules to assign per clinic monthly costs. We quantified the additiona costs to provide NCD care above those associated with existing HIV or acute care services, including clinician, staff, training, travel and equipment costs, but do not include drugs or consumables as they would be paid by the patient. We projected the budget impact of increasing CDM coverage to 50% of the eligible population from 2021 to 2025, and compared it with the county budgets from 2019. Results: The per visit cost of providing CDM care was $10.42 (SD $2.26), with costs at facilities added to HIV clinics $1.00 (95% CI: -$2:11 to $0.11) lower than at primary care facilities. The budget impact of adding 26,765 patients from 2021 to 2025 to the CDM programme was 3,088,928 under constant percent growth, and 3,451,732 under steady-state enrolment. Scaling up under the constant percent growth scenario resulted in 12% cost savings in the budget impact. The county programmatic CDM cost in 2025 was Conclusions: The budget impact of scaling up AMPATH's CDM programme will be driven by annual growth scenarios, and facility/provider mix. By leveraging task shifting, referral systems and partnering with public and non-profit clinics without NCD services, AMPATH's CDM programme can provide critical NCD care to new, rural populations with minimal financia impact. Keywords: budget impact; chronic care; costing; modelling; integrated; non-communicable disease; HIV, 1 | INTRODUCTION In low- and middle-income countries (LMICs), the burden of non-communicable diseases (NCD) is rapidly increasing due to ageing populations, lifestyle and dietary changes, rapid urbanization, and improved [...]

Health disparities exist globally in high‐income and low‐ and middle‐income countries. They are driven by social determinants of health (SDOH). While a role for pharmacists in addressing SDOH exists, a lack of structured postgraduate training limits pharmacists from being equipped to build innovative programs and contribute to health policy on SDOH in an impactful way. Postgraduate training, specifically, fellowships provides opportunities for pharmacists to develop the needed skills for working with SDOH. The Purdue University College of Pharmacy (PUCOP)‐United States Agency for International Development (USAID) Global Health Equity Fellowship was developed to meet this training need. This 2‐y fellowship represents a partnership between USAID and PUCOP. During the fellowship, time is split between USAID in Washington DC, PUCOP in Indianapolis, Indiana, and the Purdue Kenya Partnership (PKP) in Eldoret, Kenya. The fellowship was developed with a foundation of core values, the creation of a logic model, strategic partnerships, maintaining an adaptable structure, and intentional partner communication. Fellow outcomes were evaluated in three categories: engagement, education, and scholarship. Fellows completed 10 experiential opportunities between three sites and participated in the development of new and supported ongoing care programs and policy implementation in both local and international settings. Fellows completed the following educational outcomes: completed an online Master of Public Health (MPH) through Purdue Global, provided 13 educational presentations and lectures at various sites, and precepted a total of 12 PUCOP advanced pharmacy practice experience (APPE) students and 16 Kenyan pharmacy interns and Master of Pharmacy (MPharm) students. Fellows completed three publications and two abstracts at international conferences. This established training model provides pharmacists with a structured path to gain the knowledge, skills, and attitudes to be leaders in addressing Global Health Equity. [ABSTRACT FROM AUTHOR]