Improving Access to Self-Expanding Metal Stents for Patients With Esophageal Cancer in Eastern Africa: A Stepwise Implementation Strategy

Abstract

PURPOSE The eastern corridor of Africa is affected by a high burden of esophageal cancer (EC), with > 90% of patients presenting with advanced disease. Self-expanding metal stents (SEMS) have been previously reported as safe and effective for palliation of malignant dysphagia in resource-limited settings; however, access is limited throughout Eastern Africa. METHODS In response to demand for palliative interventions for patients with dysphagia because of EC, the African Esophageal Cancer Consortium (AfrECC) partnered with the Clinton Health Access Initiative to improve access to SEMS in Eastern Africa. We undertook a stepwise implementation approach to (1) identify barriers to SEMS access, (2) conduct a market analysis, (3) select an industry partner, (4) establish regulatory and procurement processes, (5) develop endoscopic training resources, (6) create a medical device registry, and (7) establish principles of accountability. RESULTS Following an evaluation of market demand and potential SEMS manufacturers, Boston Scientific Corporation announced its commitment to launch an access program to provide esophageal SEMS to patients in Tanzania, Kenya, Malawi, and Zambia at a subsidized price. Parallel regulatory and procurement processes were established in each participating country. Endoscopy training courses were designed and conducted, using the Training-of-Trainers model. A device registry was created to centralize data for quality control and to monitor channels of SEMS distribution. Principles of accountability were developed to guide the sustainability of this endeavor. CONCLUSION The AfrECC Stent Access Initiative is an example of a multisector partnership formed to provide an innovative solution to align regional needs with a supply chain for a high-priority medical device.

Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study

“…However, access to different treatment modalities is beginning to improve as governments invest in expanding the oncology workforce, developing infrastructure for radiotherapy, and essential medicines for cancer care become more broadly available. Parallel to these efforts, access to SEMS for esophageal stenting has improved in recent years as a result of coordinated efforts within AfrECC to launch the Stent Access Initiative [ 14 ]. This program, launched in collaboration with Boston Scientific and the Clinton Health Access Initiative, established the first ever sustainable supply chain of high-quality and affordable SEMS for AfrECC sites in Kenya, Tanzania, Malawi, and Zambia.…”

“…With recent enhancement of cancer services in sub-Saharan Africa, the absence of context-specific data on treatment outcomes for ESCC is manifest. Expanded availability of chemotherapy, radiotherapy, and SEMS in Eastern Africa [ 14 ], has brought to light important questions regarding optimal management strategies for ESCC in this context. To address these questions, we developed a study protocol that aims to investigate the therapeutic landscape of ESCC in Eastern Africa and compare outcomes of different treatment approaches in use across the region.…”

A viewpoint on material and design considerations for oesophageal stents with extended lifetime

“…However, within many developing nations patients must fund treatment through out-of-pocket costs, limiting the accessibility of palliative stenting. In a 2021 analysis, Mushi et al [29] explored how SEMS could be implemented to mitigate the high burden of oesophageal cancer in Eastern Africa, noting that devices should cost patients no more than $100 USD to be affordable to a majority.…”