McMaster University

McMaster University

Faculty of
Health Sciences

David Sackett award winner: improving health through new technologies

By Suzanne Morrison
Published: May 29, 2013
Lawrence Mbuagbaw
Dr. Lawrence Mbuagbaw received the first David Sackett Graduate Scholarship for his work with HIV treatment in the sub-Saharan region of Africa. Photo taken in May 2013, Cape Town, South Africa.

People living with HIV in Africa often get up at the crack of dawn, walk 25 kilometres or more to pick up antiretroviral medication (ARV) at a clinic, then spend another day walking back home.

It's a familiar scenario to Dr. Lawrence Mbuagbaw whose first job after graduating as a medical doctor from the University of Yaoundė in Cameroon was working with a mission hospital that lacked HIV treatment clinics.

When patients couldn't walk, or afford a bus or taxi, a system was set up to ensure they had continued access to lifesaving drugs and didn't stop taking them. "I used to make case reports for patients, take them to a regional hospital and present them to HIV clinicians," Mbuagbaw said. "They would prescribe medications and I would take them back to the patients, a distance of about 25 kilometres away."

The experience etched itself in Mbuagbaw's memory. Under the Canadian Institutes of Health Research's Canadian HIV Trials Network International Fellowship Program, he went on as a fellow to design the first randomized controlled trial evaluating the effect of cell phones to enhance adherence to antiretroviral therapy using weekly reminders and motivational text messages in Cameroon. The trial received international recognition, publication in major journals and several awards for Mbuagbaw.

Most recently Mbuagbaw became the first recipient of the David Sackett Graduate Scholarship, established by McMaster University's Department of Clinical Epidemiology and Biostatistics.  The $5,000 scholarship is awarded by the School of Graduate Studies to a full-time student in a PhD program.  Now in his second year, Mbuagbaw expects to receive his PhD in health research methodology from McMaster in 2015, or sooner.

"I think very highly of David Sackett so having his name on my resume feels very good," he said. "To me, the scholarship means people understand what I'm doing, that there are many unanswered questions, and that there are people who are trying to answer them."

Because of access to HIV medication in Canada, he said people rarely understand that "back home" HIV patients face stigma, difficulty accessing drugs and lack money to pay for them.

The latest UNAIDS (the Joint United Nations Program on HIV/AIDS) report estimates over 34 million people were living with HIV in 2009 with about 2.6 million new HIV infections and 1.8 million HIV-related deaths. The sub-Saharan region of Africa remains the most affected place with about 22.5 million adults and children living with HIV in 2009. The immense burden of HIV/AIDS is on individuals, families, communities and national health systems.

Professor Lehana Thabane, associate chair of the Department of Clinical Epidemiology and Biostatistics at McMaster, said Mbuagbaw "represents a new breed of health care professionals trained in research methodology" who will support front-line researchers and public health officials in sub-Saharan countries.

Sackett, a pioneer in evidence-based medicine and founder of Canada's first Department of Clinical Epidemiology at McMaster University, said "I'm terribly proud of him for receiving the scholarship and terribly proud of me for having someone so excellent receive the scholarship. He is outstanding."

Born in Cameroon, Mbuagbaw trained as a doctor at the University of Yaoundė. He obtained a Masters of Public Health from the Hebrew University-Hadassah in Jerusalem, Israel.

While studying in Israel, he was separated from his wife at home who was expecting their second daughter, and became concerned about her access to adequate medical care. Out of this very personal worry grew his master's project on looking into safe deliveries for women.

For his PhD at McMaster, he said he is "sandwiching" four papers: One paper will report on his cell phone trial, a second is a systematic review of all papers on HIV adherence in Cameroon, a third is an individual patient data meta-analysis while the fourth, a concept paper, will cover how much text messaging technology can be transferred to other conditions.

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