Lessons from the Field

Building clinical pharmacology laboratory capacity in low- and middle-income countries: Experience from Uganda

Denis Omali, Allan Buzibye, Richard Kwizera, Pauline Byakika-Kibwika, Rhoda Namakula, Joshua Matovu, Olive Mbabazi, Emmanuel Mande, Christine Sekaggya-Wiltshire, Damalie Nakanjako, Ursula Gutteck, Keith McAdam, Philippa Easterbrook, Andrew Kambugu, Jan Fehr, Barbara Castelnuovo, Yukari C. Manabe, Mohammed Lamorde, Daniel Mueller, Concepta Merry
African Journal of Laboratory Medicine | Vol 12, No 1 | a1956 | DOI: https://doi.org/10.4102/ajlm.v12i1.1956 | © 2023 Denis Omali, Allan Buzibye, Richard Kwizera, Pauline Byakika-Kibwika, Rhoda Namakula, Joshua Matovu, Olive Mbabazi, Emmanuel Mande, Christine Sekaggya-Wiltshire, Damalie Nakanjako, Ursula Gutteck, Keith McAdam, Philippa Easterbrook, Andrew Kambugu, Jan Fe | This work is licensed under CC Attribution 4.0
Submitted: 17 May 2022 | Published: 07 February 2023

About the author(s)

Denis Omali, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Allan Buzibye, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Richard Kwizera, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Pauline Byakika-Kibwika, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; and, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
Rhoda Namakula, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Joshua Matovu, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Olive Mbabazi, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Emmanuel Mande, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Christine Sekaggya-Wiltshire, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Damalie Nakanjako, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; and, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
Ursula Gutteck, Department of Clinical Chemistry, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Keith McAdam, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
Philippa Easterbrook, Department of Human Immunodeficiency Virus, World Health Organization, Geneva, Switzerland
Andrew Kambugu, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Jan Fehr, Department of Clinical Chemistry, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Barbara Castelnuovo, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Yukari C. Manabe, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; and, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
Mohammed Lamorde, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Daniel Mueller, Department of Clinical Chemistry, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Concepta Merry, Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland

Abstract

Background: Research and clinical use of clinical pharmacology laboratories are limited in low- and middle-income countries. We describe our experience in building and sustaining laboratory capacity for clinical pharmacology at the Infectious Diseases Institute, Kampala, Uganda.

Intervention: Existing laboratory infrastructure was repurposed, and new equipment was acquired. Laboratory personnel were hired and trained to optimise, validate, and develop in-house methods for testing antiretroviral, anti-tuberculosis and other drugs, including 10 high-performance liquid chromatography methods and four mass spectrometry methods. We reviewed all research collaborations and projects for which samples were assayed in the laboratory from January 2006 to November 2020. We assessed laboratory staff mentorship from collaborative relationships and the contribution of research projects towards human resource development, assay development, and equipment and maintenance costs. We further assessed the quality of testing and use of the laboratory for research and clinical care.

Lessons learnt: Fourteen years post inception, the clinical pharmacology laboratory had contributed significantly to the overall research output at the institute by supporting 26 pharmacokinetic studies. The laboratory has actively participated in an international external quality assurance programme for the last four years. For clinical care, a therapeutic drug monitoring service is accessible to patients living with HIV at the Adult Infectious Diseases clinic in Kampala, Uganda.

Recommendations: Driven primarily by research projects, clinical pharmacology laboratory capacity was successfully established in Uganda, resulting in sustained research output and clinical support. Strategies implemented in building capacity for this laboratory may guide similar processes in other low- and middle-income countries.


Keywords

therapeutic drug monitoring; building laboratory capacity; resource-limited setting; HIV; Uganda

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