Five-Year Update on the Tanzania IR Initiative: Creating a Sustainable Foundation for IR Services and Training in Sub-Saharan Africa

Monday, March 6, 2023

4:00 PM – 4:10 PM

Location: Phoenix Convention Center, 222AB

Abstract Speaker(s)

Jared M. Alswang, BS

Medical Student
Harvard Medical School

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Erick M. Mbuguje, MD

Staff Interventional Radiologist
Muhimbili National Hospital
MA

Murat Ak, MD

Post-Doctoral Research Associate
University of Pittsburgh Medical College
AN

Azza Naif, MD

Staff Interventional Radiologist
Muhimbili National Hospital
Ivan Rukundo, MD (he/him/his)

Staff Interventional Radiologist
Rwanda Military Hospital
Shin Mei Chan, BS

Medical Student
Yale University School of Medicine
FM

Frank Minja, MD

Associate Professor
Emory School of Medicine
Janice Newsome, MD, FSIR

Associate Professor
Emory School of Medicine
Vijay Ramalingam, MD

Vascular Interventional Radiologist
Beth Israel Deaconess Medical Center
Fabian M. Laage Gaupp, MD

Interventional Radiologist
Yale School of Medicine

Disclosure(s):

Jared M. Alswang, BS: No financial relationships to disclose

Ivan Rukundo, MD: No financial relationships to disclose

Janice Newsome, MD, FSIR: Boston Scientific: Advisory Committee or Review Panel Member (Ongoing); CARESTREAM: Research Grant Recipient (Ongoing); Cook Inc: Consultant (Ongoing); Medtronic: Research Grant Recipient (Ongoing); TVIR: Co Editor (Ongoing)

Vijay Ramalingam, MD: No financial relationships to disclose

Fabian M. Laage Gaupp, MD: No financial relationships to disclose

Purpose: Access to interventional radiology (IR) in sub-Saharan Africa (SSA) is severely limited with the specialty’s many benefits out of reach to over one billion people living in the region {1}. To address this urgent need, a training model for countries without prior IR expertise was designed and first implemented in Tanzania. We here review the experiences of the first five years since conception of this program and evaluate the feasibility of this model to facilitate the growth of IR services and training across SSA.

Materials and Methods: Following an IR readiness assessment in October 2017, IR training in Tanzania began in October 2018 through monthly deployment of visiting teaching teams, including an IR attending, technologist, and/or nurse, for hands-on training combined with in-person and remote lectures. A competency-based two-year Master of Science (MSc) in IR curriculum with structured written and oral exams was inaugurated at the nation’s main teaching hospital in October 2019, graduating its first two classes in 2021 and 2022. Procedural data, demographics, and clinical outcomes were prospectively recorded in a Research Electronic Data Capture (REDCap) database throughout the duration of the program and comparative (utilizing Pearson’s chi-squared test) and descriptive analysis was performed.

Results: From October 1st, 2018 to July 31st, 2022, 1,595 procedures were performed in Tanzania: 1,236 non-vascular and 359 vascular, all with local trainees as primary operators. 96.9% were technically successful, 95.1% were without complication, and 19.0% were performed independently by Tanzanian trainees and faculty. There were no significant differences in complication and technical success rates in procedures performed independently as compared to when supervised by visiting faculty (p=0.65 and 0.71, respectively). Ten IRs have graduated from this program, increasing the number of IRs in Tanzania, Rwanda, and Nigeria from one to eleven (combined population of nearly 300 million). Newly graduated local faculty are now gradually taking over teaching responsibilities, allowing a transition to local autonomy. A training program in Rwanda mirroring this structure, spearheaded by a graduate of the Tanzania program, has been approved to begin in January 2023 and another in Uganda is pending approval to begin in October 2023.

Conclusion: The reported training model offers a practical and effective solution to meet many of the challenges associated with IR capacity building in SSA. Future directions include expansion of this model to other resource-limited nations currently lacking IR.