Translating Ethics into Practice (Record no. 27945)
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| fixed length control field | 05484nam a22003017a 4500 |
| 001 - CONTROL NUMBER | |
| control field | 20240606190910.0 |
| 003 - CONTROL NUMBER IDENTIFIER | |
| control field | 20240606190910.0 |
| 005 - DATE AND TIME OF LATEST TRANSACTION | |
| control field | 20240606191640.0 |
| 008 - FIXED-LENGTH DATA ELEMENTS--GENERAL INFORMATION | |
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| 040 ## - CATALOGING SOURCE | |
| Transcribing agency | ddc |
| 041 ## - LANGUAGE CODE | |
| Language code of text/sound track or separate title | English |
| 100 ## - MAIN ENTRY--PERSONAL NAME | |
| Fuller form of name | Cody Cichowitz |
| 245 ## - TITLE STATEMENT | |
| Title | Translating Ethics into Practice |
| Remainder of title | Providing Long-Term Cardiometabolic and Cardiovascular Disease Care for Research Participants in Africa |
| 260 ## - PUBLICATION, DISTRIBUTION, ETC. | |
| Place of publication, distribution, etc. | Mwanza, Tanzania : |
| Name of publisher, distributor, etc. | Catholic University of Health and Allied Sciences [CUHAS – Bugando] : |
| Date of publication, distribution, etc. | 2023 |
| 300 ## - PHYSICAL DESCRIPTION | |
| Extent | Pages 01-04 |
| Extent | Includes References |
| 490 ## - SERIES STATEMENT | |
| Series statement | Global Heart. 2023; 18(1): 34. |
| 520 ## - SUMMARY, ETC. | |
| Summary, etc. | In sub-Saharan Africa (SSA), health systems face significant challenges responding to the growing burden of cardiometabolic and cardiovascular diseases (CVDs) [1,2], and most adults in SSA lack access to primary care [3]. Consequently, many research participants will be diagnosed with untreated cardiometabolic and cardiovascular disease during internationally funded research. In 2019, we argued that there is an ethical imperative for researchers in SSA and other low-income settings to facilitate the ‘highest achievable standard of care’ for all untreated non-communicable diseases identified during research [4]. However, no standards exist for researchers to implement this ethical imperative and facilitate long-term access to treatment.<br/><br/>Over the past four years we have been working to ensure long-term access to cardiometabolic care for participants in our own ongoing CVD cohort in Tanzania [5,6,7]. Prior to study initiation, we committed to provide free access to treatment for newly diagnosed hypertension, diabetes, coronary artery disease, and heart failure. Our group’s experience illustrates many opportunities and challenges associated with securing long-term cardiometabolic and CVD treatment during research.<br/><br/>In our cohort of 1,000 adults who have been engaged in an observational study for the last seven years, 180 (18%) of participants have been diagnosed with a new non-communicable disease, including hypertension (n = 98), diabetes (n = 61), and CVD (n = 26). As demonstrated in Figure 1, our outcomes for hypertension treatment and control are much better those reported in the Tanzania community [8,9], but still more work is needed. For participants diagnosed with diabetes, medication uptake (7 of 61) and glycemic control (5 of 61) has been unacceptably low. All participants with symptomatic CVD adhered to recommended care, yet we often struggled to link participants to long-term subspeciality care.<br/><br/>Learning from these data, we have identified several barriers to ensuring long-term access to cardiometabolic and CVD care and have implemented several solutions. We recently hired a medical doctor who connects participants with treating clinicians and ensures guideline directed therapy is offered. We also now provide health insurance to participants diagnosed with CVD to improve linkage to subspeciality care. We have created feedback systems so that treating clinicians are aware of participants with cardiometabolic or cardiovascular disease who have not initiated medication, are non-adherent, or have not achieved disease control. In collaboration with treating clinicians, we have also developed standardized educational information, referral pathways, and treatment algorithms. Together with our partners in health system leadership, we believe that these efforts can help to improve CVD care beyond our own study.<br/><br/>The annual costs associated with diagnostics, medications, insurance, and study team effort amount to ~$10,000 USD, which are paid for from private funds. While not insignificant, these costs are nominal compared to our annual NIH funding of over $500,000 USD.<br/><br/>We acknowledge that research should remain independent from clinical care, yet we maintain that the limited availability of CVD care in SSA necessitates that researchers actively work to secure basic health care and human rights for participants. We must partner with local health systems to foster sustainability of treatment. In solidarity with many HIV researchers who came before us and helped ensure immediate access to ART prior to widespread availability, we believe that the imperative to provide lifesaving treatment requires immediate action and advocacy.<br/><br/>Researchers have a moral obligation to ensure that research participants have durable access to the highest possible local standard of care for cardiometabolic disease, CVD, and other untreated non-communicable diseases. Funding agencies should allow for the purchasing of medication and health insurance and evaluate research based upon plans to address cardiovascular health during and after project implementation. Journals should require investigators to describe access to non-communicable disease care for participants. Finally, researchers should engage community stakeholders to advocate for high-quality CVD and cardiometabolic care. These changes are essential to fostering equity in global health research and maximizing the impact of scientific inquiry in Africa. |
| 700 ## - ADDED ENTRY--PERSONAL NAME | |
| Fuller form of name | Robert Peck |
| Fuller form of name | Saidi Kapiga |
| Fuller form of name | Anthony O. Etyang |
| Fuller form of name | Bernard Desderius |
| Fuller form of name | Bahati Wajanga |
| Fuller form of name | Grace Ruselu |
| Fuller form of name | Godfrey Kisigo |
| 856 ## - ELECTRONIC LOCATION AND ACCESS | |
| Uniform Resource Identifier | <a href="https://doi. org/10.5334/gh.1206">https://doi. org/10.5334/gh.1206</a> |
| Link text | https://doi. org/10.5334/gh.1206 |
| 942 ## - ADDED ENTRY ELEMENTS (KOHA) | |
| Source of classification or shelving scheme | ddc |
| Koha item type | RESEARCH ARTICLES |
| Suppress in OPAC | |
| Withdrawn status | Lost status | Source of classification or shelving scheme | Damaged status | Not for loan | Home library | Current library | Date acquired | Total checkouts | Barcode | Date last seen | Price effective from | Koha item type |
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| MWALIMU NYERERE LEARNING RESOURCES CENTRE-CUHAS BUGANDO | MWALIMU NYERERE LEARNING RESOURCES CENTRE-CUHAS BUGANDO | 06/06/2024 | 20240606190910.0 | 06/06/2024 | 06/06/2024 | RESEARCH ARTICLES |