||Dr. Marya Lieberman
||Mr. Ibrahim Chikowe
||Pharmaceutical Quality in Malawi
||Access to healthcare; Medication quality
||We developed a paper test card to quickly detect falsified pharmaceuticals in field settings in Malawi. Mr. Chikowe trained workers at eight rural clinics to use the card, and the success of that use case inspired further development of the paper test card to include illicit substances and cutting agents commonly found in street drugs in the US. This intervention is now being applied within Indiana and Illinois in partnership with Deputy Coroners (first responders who encounter overdose death scenes) and harm reduction organizations.
||Intervention transfer is being facilitated by the CTSI programs in Indiana and Illinois. We are working with Chicago Recovery Alliance and University of Chicago COIP sites. In Indiana, we have a separate project working with the Chief Deputy Coroner, Alfie Ballew, to evaluate drugs and drug paraphernalia found at the scenes of overdose deaths.
||The intervention targets Malawian citizens exposed to bad quality antibiotics and in the US, people who use illegal drugs. Both are vulnerable populations who are exposed to harm from the products they are using.
|Process to Implementation
||A test card was optimized for detection of illicit drug components. We worked with the Berrien County forensic lab to validate the card against real street drugs. Next we trained counselors to collect street drug samples at CRA and COIP sites. We found different cutting agents in use at these sites and had to retune the test card. The next step will be training drug counselors to run the test and advise drug users on how to modify their use to reduce risk of harm.
||Stakeholders include the police, EMTs, firefighters (first responders). Drug counselors and other staff at CRA and COIP. People who use drugs. People who sell drugs. Other drug checking organizations. 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 and regulatory agents.
|Scaled or Transferred?
||We are using the idPAD card to test drugs in Indiana and Illinois.
|Type of Research
||Development of the idPAD required basic research; getting it into clinical/harm reduction settings required both basic research (to characterize the cutting agents and “products” in this “market”) and also implementation research. For our implementation process, we evaluated the main causes of overdose deaths through our collaboration with the Deputy Coroner in Indianapolis. Then we redesigned the idPAD so it could detect the main risk elements (fentanyl, other opioids, meth, and benzos). The research involved machine learning to processed the idPAD color bar codes, and development of a phone app is in progress with funding from the NSF PFI-TT program. We are now working with the drug counselors and people who use drugs to see what information they need to support choices for safer use behavior.
||1. idPAD: Paper analytical device for presumptive identification of illicit drugs. Tracy-Lynn E. Lockwood,* Tammy Leong, … Sarah L. Bliese,* Alec Helmke, … Alex Richard, … Getahun Merga, John Rorabeck, and Marya Lieberman. J. Forensic Science, 2020, 65:4, 1289-1297
2. Enzyme-based paper test for detection of lactose in illicit drugs. Jessica Zinna*, Tracy-Lynn Lockwood*, Marya Lieberman. Analytical Methods 2020, 12, 1077 – 1084
3. Amoxicillin Quality and Selling Practices in Urban Pharmacies and Drug Stores of Blantyre, Malawi. Chikowe, Ibrahim; Bliese, Sarah L.*; Lucas, Samuel…; and Lieberman, Marya. Am J Trop Med Hyg. 2018 99(1) 233-238. DOI: 10.4269/ajtmh.18-0003.
Two other manuscripts in review.