The West African Network of Excellence for TB, AIDS and Malaria (WANETAM) is now in its third year. Funded by the EU European Developing Countries Clinical Trials Partnership, WANETAM’s mission is to build capacity at West African sites for clinical trials in HIV, TB and malaria.
MRC Unit The Gambia is one of three Nodes of Excellence in the WANETAM consortium and is the focal point for TB; the other two Nodes are situated in Senegal under the leadership of Professor Souleymane Mboup (Chiekh Anta Diop University, Dakar – HIV) and in Mali under Professor Ogobaro Doumbia (University of Bamako – malaria). The Gambia NoE is led by Professor Tumani Corrah (Unit Director) and Dr Martin Antonio (Senior Scientist & Unit Molecular Biologist).
The two previous training programmes held at The Unit focused on the basic science and myco-bacteriology. This year’s programme titled ‘Molecular Epidemiology of MDR TB in West Africa’ set out a more ambitious agenda of preparation for multi drug resistant TB surveillance in West Africa, and included sessions on DNA extraction, how to set up a PCR laboratory and spoligotyping.
Preparations for MDR TB surveillance
One of the specific tasks of WANETAM is to do a MDR TB survey in West Africa. Dr Antonio says ‘When you look at the map of the world, you’ll see that it’s only in West Africa that such data doesn’t exist. So we thought that one way WANETAM can make a mark is to provide data on the prevalence of MDR TB in our sub-region.’ Each of the WANETAM sites will be required to grow the TB bug, which will then be collected for genotyping. Dr Antonio continues ‘We conducted training on how to perform the genotyping experiment – a new method for sub typing TB and also for determining the resistance patterns using molecular diagnostic methods…Many of the participants had never done this before.’
Bridging the gap
MRC is fortunate to have all the equipment and resources in The Gambia to conduct such training, perform the tests and generate the data. However, as Dr Antonio says ‘in some of the sites equipment is sitting in labs in unopened boxes. We hope that by undergoing this training the participants will be able to start using some of this equipment back home.’
Some of the sites have also made funding applications to international agencies to buy molecular diagnostics equipment; but where sites do not have the equipment they are encouraged to come to The Unit with the isolates and work with the MRC’s TB diagnostics team to generate their data. So, as Dr Antonio says ‘not having the equipment should not be a limitation. And this will be a way of building capacity which is slightly different from basic science training we do.’
Two further training programmes are planned to take place before the end of the year. Dr Antonio says ‘In the next one we are going to use a high resolution genotyping method, DNA sequencing type training – another method that can be used to refine the typing that we used for the previous training.’ The first training will also be repeated to give a new cohort of lab staff the opportunity to benefit.
The WANETAM grant ends this year, but funding has been provided by the EDCTP for WANETAM Plus, and this will run on immediately after the conclusion of WANETAM. Dr Antonio says ‘WANETAM Plus is built on the principles of WANETAM, but in this case we will extend the network to include Benin and Togo. WANETAM Plus will be coordinated by the MRC: Dr Assan Jaye (MRC senior scientist based at Cheikh Anta Diop University, Dakar) will be leading on HIV; Professor Umberto d’Alessandro (Theme Leader – Disease Control and Elimination, MRC Unit The Gambia) is the malaria focus and I’ll continue with Professor Corrah as leaders of the TB package.’
Part of WANETAM’s mission is to undertake site visits, and some of the greatest dividends have been seen in the sub-region’s laboratories. Dr Antonio says ‘Take a site like Accra for example. When we started WANETAM, the lab was not doing TB cultures, as there were problems with equipment, expertise and infrastructure. But through the WANETAM network, they were able to refurbish the labs at Korle Bu Teaching Hospital and now they are doing TB cultures routinely. Recently that lab has been nominated as the national TB reference laboratory for Ghana. This is a huge achievement, and I think we should all be very proud.’