Interview with Tonia Arua - Clinical Trials, Healthcare, and Participant Recruitment in Africa

Article By Samantha Trolli IN News - 20th July, 2022

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Tonia Arua is a certified nurse who runs a program in bioethics where she focuses on clinical trials. While in Nigeria, I had the pleasure to interview her regarding the healthcare system and functionality of clinical trials in Africa. Below is the transcript from our conversation.   

Q: With your experience in healthcare over the past few years how have you seen advancements in Africa?
A: It has advanced greatly, there are new drugs and new ways of administering them. In treatments of malaria, before now you could just take chloroquine - either in ejection or tablet, but currently there are different levels of treatment given. Before you didn’t need to do a malaria process investigation, but currently you need to do a laboratory investigation before you commence treatment because it may not be malaria. The treatments have been advancing when it comes to Malaria in Africa. 

Q: With the treatments you’ve seen advance, what you’d you say is the most promising advancement?
A: The most promising advancement is in new discoveries of drugs and medicines. It is helping to treat even the emerging diseases. Most of the drugs are unlike the previous ones, you might have had to take certain medications maybe 4 times a day – but with the advancements you can now have a daily drug that has a long acting time, so that you can take it and the next time you take it is 6 hours, some 12 hours. Before now you only had drugs that had 3 hour intervals, but now you can just have daily drugs - antibiotics that are long acting. The treatment is given and people recover even faster, except the cost has increased.  

Q: With all of these great advancements, where do you see the need for increased attention? In other words, what area do you see not advancing that needs to advance? 
A: I think we have more problems that are arising from what people eat. It is causing more problems, bringing up more diseases. So research is needed more in this area to find new medications that can treat and help people. Some people cannot control their appetite or maybe culturally there are things that they are used to and over time these types of foods have started to cause diseases. In the level of antibiotics, I also think that there should be advancements. Or, because of the cost of living, if there is any way that drugs can be cheaper for low and middle income countries. We would still do the same work but medicine would be more affordable for the ones who need it to be, that would be very beautiful.  

Q: Through the years of your work in healthcare, what technology has been put in place that you have seen be the most beneficial to the healthcare system in Africa?
A: Well honestly, this is where the problem is. Some of these machines we have, have not actually been put in use. What also happens is that the appropriate machines or the ones that are of quality, are not provided. As a nurse, they provided computers so that you don't need to be carrying papers around, but they are also not in use currently. They are there, they are valuable, but I don’t think they are of quality that will give out what is required. It should be less stressful to order your drugs from the pharmacy, or get your laboratory results, or coordinate the activities of the patient when using these computers. While we are currently not where the world is going. It is not as if we don’t know, but we have not started using some of the equipment that the rest of the world uses.  

Q: What is a piece of technological equipment that you think would be most useful to have in your practice? 
A: What we need is to have the computer system in use. It reduces time wasted, for every activity that we do. We can easily communicate to the next person and get an answered response. You don’t have to make mistakes in your drug administrations, because through it, it is not as if someone has just prescribed a hard copy and then you can’t read someone's writing. With it, medication is easier, time is carteled. Things which are useful are oxygen pipes and movable x-ray machines. So that patients who are critically ill, we don’t need to move them around. 

Q: Why do you think that clinical trials are important?
A: Clinical trials are very very important, because they pass through several stages. The project has to be documented and written with full details. Details about confidentiality, consent, methodology, and more. All details will be looked through, and in this process if there are issues or problems they will be noticed. Then, after that stage has passed and IRB approval has been given, the clinical trial must pass through more stages of being processed. In drug production, it will first be tested in animals. Eventually, if there are issues they will be solved. So if a clinical trial is not done, there will be death, there will be tragedies, it would be catastrophic. How could one know if the body will respond well to a treatment? We need clinical trials, they are good and they are certain for society at large. 

Q: In what ways can we promote participants to engage in clinical research? Especially in Africa. 
A: In Africa, we run a patriarchal family system. The head of the family can give consent for any member of the family to participate in clinical trials. So the system here is a bit different. Because of this, you are going to have to engage the chief or royal heines that oversees the community or village. The people listen to such a person. So once he understands what you want to do after you have explained, only if he thinks it is something that will benefit the community or village, will he then accept it. Once you have obtained community consent, they will not fight against what your institution wants to do. After this, during the actual clinical trial, those people who have willingly submitted themselves to participate have to give consent.

Q: Does the researcher always have to go out and recruit participants? Or do participants ever come to the researcher to participate?
A: Most of the time, you have to go out and recruit. Once the possible participants are aware of what could happen and that they can come to participate, those who want to be a part of the trial will come. Although it does depend on the type of trial you are trying to conduct. 

Q: Do you ever struggle with communicating during these times of recruitment?
A: It is a process, we have to communicate in the local language. Even if it means demonstrating for them to understand.

Q: Do you see any struggles with maintaining participants?
A: The rule is that when you are getting consent, you tell the person you are free to continue to the end and you also are free to not continue. It is something you have to do. The important thing is making sure that they will not drop out. We cannot guarantee everyone will stay to the end, this is human research, they are social beings. Their mood can change at any moment and they can opt out, they may see something they don’t like and decide to leave. But what is also important, is to develop trust with the participants. In clinical trials, you also have to give room to handle some of their health issues that may arise – ones that are not a part of the research you are conducting. So if you do not build this in and you see they have challenges in their health and you don’t take care of them, other may people see this. These other people may say no I think I am in trouble. They may think if what if we have problems and cannot be helped? They may opt out then. For example, someone may develop malaria during your clinical research, you have to treat them so that they can continue in your research. If you do not take care of your participants, it may affect other people. Some people may change their mind and exit with the other people who are not well taken care of. So in clinical trials, it is important that the researcher adapts. If something happens, they must be able to handle it. If it is something that is not in the budget, the researcher must communicate this and something else has to be done. 

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