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When COVID-19 hit in Tanzania, a cloud of doom came over the Eye Health Programme, a collaborative research program between Kilimanjaro Christian Medical University College (KCMUCo) and London School of Hygiene and Tropical Hygiene (LSHTM), which I work on. We were already one year late to start a randomized controlled trial looking at chlorhexidine as an alternative treatment to the standard of care, natamycin, for fungal keratitis. Natamycin is not affordable for most patients living in areas with higher prevalence of fungal corneal infections and chlorhexidine could be an affordable and effective alternative. This multicentre trial is being conducted at KCMUCo in Tanzania, Mbarara University of Science and Technology in Uganda and Sagarmatha Coundhary Eye Hospital in Nepal.
In March, we obtained approval from Tanzania Medicines and Medical Devices Authority (TMDA), our last regulatory approval needed to start the trial and then COVID-19 hit Tanzania. However, due to the COVID-19 pandemic, the government of Tanzania paused all research in the country in April. We still had to import the Natamycin from India but the company was busy exporting Personal Protective Equipment (PPE) and essential medicines of which Natamycin was not considered. Although there was no lock-down in Tanzania, many made the choice to isolate and our group didn’t want to ask people to move around outside their home. So we struggled to obtain the required original TMDA import permit to come from Dar es Salaam.
In addition, we had clinical supplies at LSHTM that needed to be shipped to Tanzania but the school was closed and shipments were not easy to arrange especially with initially no flights to Tanzania. Eventually life in Tanzania opened up albeit more slowly than in UK and India. We eventually managed to get the shipments needed. But with our administrator in London unable to travel to Tanzania, who could do the important task of randomizing the study drugs? By early August all our approvals, equipment, supplies and medicines were at KCMUCo ready to start the trial. Our next hurdle was – will patients turn up to the hospital? – a very real challenge during COVID. But as one of the major causes of corneal
infection is agricultural activities, August was harvest season and patients were coming to KCMUCo. With PPE, dividers put on our slit lamps and additional protective measures required of patients, we successfully started the trial on 1 September 2020 when we enrolled our first patients.
