Study Evaluates 5-Year Growth and Outcomes of an IR Training Model Introduced in Sub-Saharan Africa

KEY FINDINGS

• Overall technical success and adverse event rates were 97.2% and 4.8%, respectively.
• There were no significant differences in technical success or adverse event rates between supervised and independently performed procedures.
• The majority of procedures performed were nonvascular, with no statistically significant differences seen in technical success or adverse event rates among any analyzed procedural class.
• Fewer than 30% of procedures were performed in the absence of a visiting teaching team, and a statistically significant difference was noted in the frequency of procedures performed independently versus supervised between procedural classes.
• 42 IR teams were deployed to Tanzania during the study period, with 10 IR fellows graduating during that time.

ENDOVASCULAR TODAY ASKS…

Study authors Jared M. Alswang, BS, with Harvard Medical School in Boston, Massachusetts, and Fabian Laage Gaupp, MD, with Yale University School of Medicine in New Haven, Connecticut, were asked about the specifics of the IR training program, how it has evolved over time, and next phases.

What does the training program comprise?

The training program in Tanzania was designed to mirror the established training model in the United States (2 years of dedicated IR training, preceded by a diagnostic radiology residency). The main difference was that at the start of the program, there were no local IR faculty to spearhead training efforts. As such, we had to start without any local teaching faculty, requiring us to fly in a team of teaching faculty, nurses, and technologists for at least 2 weeks every month until enough IR faculty in Tanzania graduated to then sustainably carry on the program on their own. An additional layer of complexity is that, alongside learning the skills and knowledge required to become interventional radiologists, trainees must also concentrate on practice building to help establish and expand the specialty from scratch in new settings.

With 10 physicians graduating from the program during the study and a pace of three per year continuing after, has the training program evolved as more individuals have passed through it?

Absolutely. The program has evolved quickly. When we first started our monthly teaching trips to Tanzania in October 2018, we only did biopsies, biliary drains, abscess drains, and nephrostomies. Over time, we added more procedures, including uterine fibroid embolization, splenic artery embolization, central venous access and recanalization, transarterial chemoembolization, transjugular intrahepatic portosystemic shunt creation, and a whole range of pediatric IR procedures, meaning that we can now cover the entire spectrum of IR procedures available to patients in the United States, with few exceptions (ie, yttrium-90 radioembolization and ablation). In addition, the training program has grown in local autonomy and independence. The initial trainees who joined in 2018 now fully run the IR service and have grown into local leaders in both education and clinical care.

Similarly, partner programs have since begun in Uganda and Rwanda. What has the group learned about the scalability of the training program from one place to the next?

We have learned many lessons along the way. Local buy-in is essential. A great deal of the program’s success has come not just directly from the efforts of the IR trainees in the program, but also from the many individuals who have provided support locally and are committed to the growth of IR in East Africa. In terms of international partnership, a structured approach with open channels of communication and tight coordination is also crucial. Given the diversity of skills and background from the many volunteers who have contributed, the scalability of this program has depended on strong organization. With all of this in mind, the template developed in Tanzania has been transferable to our new partner programs in Uganda and Rwanda. Most importantly, we recognize that these programs are not only urgently needed, but with the close collaboration and dedication observed thus far, it is indeed possible to establish state-of-the-art IR training in East Africa, an achievement unprecedented before this initiative.

What are the plans for next phases of the Road2IR program?

The hope is to expand similar training programs to any country that needs it. Unfortunately, funding is the limiting factor. We run an incredibly tight ship and have kept our annual budget to well below $100,000. Despite this limited budget, we are celebrating our 100th teaching trip to East Africa this July 2024. Our funds come mostly from small grants and donations by participating faculty. However, as we expand to more countries, this is not sustainable, and we are in urgent need of larger grants or donations and new strategic partnerships. Any tips and recommendations are greatly appreciated.