Curative options for sickle cell disease in Africa: Approach in Tanzania

There is an urgent need to develop a strategy for curative options for sickle cell disease (SCD) in Africa as this is a disease of public health significance. It is common [84% of 14 million children born (2010-2050) in the world are in Africa]; survival in Africa is reported to be low however with interventions, childhood survival can reach between 50% and 90%. Tanzania, a low-middle income country, has 11,000 children born every year and estimates that at least 14,700 deaths in under five years old are due to SCD. Tanzania had an existing dedicated sickle cell clinic at Muhimbili National Hospital, established in the 1980s. In 2004, Muhimbili University of Health and Allied Sciences (MUHAS) established a research programme that integrated improving health services, advocacy and training and enrolled 5,466 patients. In 2016, sickle cell services strengthened in other health facilities. As part of the strategy for healthcare, the Sickle Cell Programme worked with the Ministry of Health to develop recommendations for comprehensive care at different levels of health care. Most countries in Africa wanted to ensure that comprehensive care was available before putting in place curative therapy such as Haematopoietic Stem Cell Transplantation (HSCT). However, factors that accelerated the need to develop a strategy for curative care including progress and better outcomes in transplantation, increase in demand and investment in tertiary healthcare facilities. Tanzania is exploring transplantation services in 4 tertiary level referral hospitals and using the progress in genomic research in Africa to participate in gene therapy. Tanzania has successfully established training for health professionals with formal programmes and continuous medical education as well as staff exchange programmes with different partners including UK and USA. Advocacy involves active engagement with the SCD community with partnership with community organisations. Tanzania has demonstrated that there is progress in developing a strategy for curative therapies for SCD in Africa but has emphasized the need for these efforts to complement comprehensive care. A model that has proven to be successful in Tanzania integrates health, advocacy, research and training and can be used in establishing curative therapies in Tanzania as well as other countries in Africa.