Clinical Trials at the University of Witwatersrand, Johannesburg

There is so much to say about this topic. For this week note, I will limit myself to the visits with the Wits Health Consortium. I should mention that Wits is the short version of the university name, just as Joburg is the short version of the South African city.

I had the pleasure to meet with the CEO and founding CEO of the Wits Health Consortium, Alf Farrell and Josh Fisher. When I introduced myself, I noted that I was impressed by their annual report. In typical South African style and humor, Josh immediately congratulated Alf, stating that at least one person has read the report.

The meeting quickly turned more serious when we started discussing the types of clinical trials within Wits Health. In the table of contents of the report, shown below, the listing of research and institutes indicates the breadth of activities, with a strong focus on HIV. Alf explained that in their current portfolio, about 80% is on HIV/AIDS, with sponsors primarily from philanthropic organizations. It was clear from the report that they were enabling clinical trials not only within the university, but also throughout Sub-Saharan Africa.

Our discussion then turned toward our Clinical Trials Systems Project. We started exploring some of the pathways towards more effective and efficient trials and some of the current challenges. It then became clear that their mode of operation was in many ways very similar to that of the Columbus Regional Research Institute (CRRI), which our research team visited a few weeks ago. (See Week Note 13.) For instance, Wits Health provides administrative, regulatory and managerial support to investigators to allows these researchers to focus on the clinical and scientific aspects of their work. The success of this model mirrors the success we noted at CRRI.

After our meeting, I was brought to one of the Wits Health clinical research sites within the Donald Gordon Medical Centre, an academic hospital affiliated with Wits University. I was surprised to see how the office organization, staffing, and layout were similar to what we saw at CRRI and at Mercy Hospital. (See Week Note 14.) I probed a bit, asking if they also had multiple EKG machines of different brands to suit different sponsor requirements. They said yes, although they typically had to return the machines soon after the studies were completed. When I saw the data entry staff, they initially didn’t look up from their computer monitors. But when I asked about how they felt about queries, they immediately spoke up, with the same complaints that we heard at CRRI and Mercy.

The challenge of most interest to Alf and Josh was PI retention. I noted that Jeff Kingsley, the CEO of CRRI had developed his organization with an eye towards addressing this issue, and that he was constantly exploring ways to improve retention. So, a few days later, I connected the three of them together through Skype to express their difficulties and exchange possible solutions.

The CRRI setting within Columbus, Georgia and the Wits Health setting within Johannesburg, South Africa are profoundly different in ways that are difficult to express in words. But, as we know from ethnography, a comparison of methods developed in such different settings often provides insights that are not possible to obtain within a single setting. So, I have hope that these clearly committed CEOs will find new insights in making clinical research more accessible to their investigators.

Tak Igusa