||Dr. Sonak Pastakia
||Evaluation of locally-sourced compression therapy for treatment of chronic venous leg ulcers and management of Kaposi sarcoma leg lymphedema in western Kenya
||Compression therapy, part of routine clinical care, is well-established cornerstone therapy for chronic leg ulcers from venous disease and lymphedema, including Kaposi sarcoma (KS)-associated lymphedema. The provision of compression therapy in resource-limited settings, as in western Kenya and other regions of East Africa, is a major challenge. This project will utilize a longitudinal cohort study to follow patients for 12 weeks to 1) evaluate the efficacy of compression therapy for the treatment of chronic venous leg ulcer patients seen at Turbo Health Center, one of the Academic Model for Providing Access to Healthcare (AMPATH) sites, and 2) explore the utility of compression therapy in the management of KS leg lymphedema patients seen at AMPATH oncology sites.
||This intervention is being piloted in Kenya with support of the public health system run by the Kenyan Ministry of Health. Stakeholders include patients with HIV, their caregivers, medical partners, and researchers. Additional partners include international partnership between the Academic Model Providing Access to Healthcare (AMPATH) and the Infection Disease Institute in Uganda. The Indiana CTSI is developing a program focused on reciprocal innovation that seeks to support the identification, adaptation, implementation, and evaluation of promising interventions developed at LMIC partner sites for use in Indiana. This infrastructure provides funding and other resources to adapt interventions to a US context.
||Patients with chronic venous leg ulcers presenting to Turbo Health Center, including: Older than 18 years of age; Diagnosis of a venous ulcer, defined as a wound of the lower extremity in an individual with adequate lower extremity arterial flow located in the gaiter region of the leg (between the knee and ankle) with clinical signs of venous disease; Presence of the venous ulcer for more than 6 weeks; Individuals who provide written consent to participate
|Process to Implementation
||This intervention has not yet been implemented in Indiana but is being piloted in Kenya. If the pilot findings show positive outcomes, potential exists to apply this intervention to low resourced clinical settings in Indiana and the US. Following identification of potential pilot sites in Indiana, this intervention could be adapted and piloted for use in the US clinical context using support from the Indiana CTSI and other health partners in Indiana, e.g. State Department of Health, IU Health, Eskenazi, and other public health centers.
||Stakeholders include adolescent patients, their caregivers, and medical partners, and researchers. We anticipate in transferring to the US that there would need to be similar stakeholders that would need to be engaged within the health systems.
|Scaled or Transferred?
||The aim is to work toward scaling this process into the US setting. The limited prevalence of Kaposi Sarcoma in the US and the availability of wound dressings has limited the applicability of this intervention to US populations.
|Type of Research
||Prospective observational study
||1. Chang AY, Mungai M, Coates SJ, Chao T, Odhiambo HP, Were PM, Fletcher SL, Maurer T, Karwa R, Pastakia SD. Implementing a Locally Made Low-Cost Intervention for Wound and Lymphedema Care in Western Kenya. Dermatol Clin. 2021 Jan;39(1):91-100. doi: 10.1016/j.det.2020.08.009. Epub 2020 Oct 31. PMID: 33228865; PMCID: PMC7686544.
2. Chang AY, Karwa R, Busakhala N, Fletcher SL, Tonui EC, Wasike P, Kohn MA, Asirwa FC, Kiprono SK, Maurer T, Goodrich S, Pastakia SD. Randomized controlled trial to evaluate locally sourced two-component compression bandages for HIV-associated Kaposi Sarcoma leg lymphedema in western Kenya. The Kenyan Improvised Compression for Kaposi Sarcoma (KICKS) study protocol. Contemp Clin Trials Commun 2018; 21;12:116-122. doi: 10.1016/j.conctc.2018.10.003.
3. Chang AY, Tonui EC, Momanyi D, Mills AR, Wasike P, Karwa R, Maurer TA, Pastakia SD. Development of low-cost locally sourced two-component compression bandages in western Kenya. Dermatol Ther (Heidelb). 2018 Sep;8(3):475-481. doi: 10.1007/s13555-018-0248-z. Epub 2018 Jun 15.