In August 2013, I started my journey toward a master’s degree at Makerere University’s Department of Pharmacology and Therapeutics. The master’s program, a rigorous two-year endeavour, comprised 1 year of lectures and coursework and 1 year of research. As a self-funded student, I was acutely aware of the financial implications of my decision to pursue a master’s degree, particularly the cost and duration of my research project. The question of how I would fund my research was ever-present.
As the end of my first year approached, a notice about an upcoming seminar caught my attention. The topic of the seminar was unfamiliar to me: pharmacometrics. Dr. Ene Ette (from Anoixis Corporation in Massachusetts) and Dr. Joel Owen (who was with Cognigen and Union University in Jackson, Tennessee at the time) were slated to conduct the seminar, which was organised by Dr. Jackson Mukonzo, then head of the Department of Pharmacology and Therapeutics, and two final-year students, Kuteesa Bisaso and Francis Ojara.
The first day of the seminar opened with the basics of pharmacokinetics, and things quickly became more complex. We soon found ourselves loading software, experimenting with models, and attending a series of detailed lectures. Although much of the content was challenging to absorb, especially in such a short time, I quickly recognized the potential: manipulate a few lines of code, input a dataset, and let software handle the rest. I was intrigued, not least because this seemed much more interesting than the project I was considering—studying the effects of allium species on the memory and cognition of rats. At the time, working with rats was the most economical choice, yet the thought of feeding, observing, and eventually sacrificing them wasn’t appealing. The expenses associated with writing and getting approval for a human subject research protocol, as well as compensation for research participants, were even more prohibitive. Thus, the novel modelling approach discussed in the lectures presented the breakthrough I needed for my research project.
“Honey, it’s either rats or this new thing called pharmacometrics. It’s a steep learning curve, but it sounds interesting. What do you think?” I said to my then-boyfriend and now-husband. His response was instant: “Go the novel way.”
Fortunately, my classmate, Suzan Karungi, was equally fascinated by pharmacometrics and Dr. Mukonzo had a rich dataset on efavirenz from his PhD research that he was happy to let us use. Kuteesa, who had just completed his master’s degree, became a mentor to Suzan and I. He patiently guided us through the intricacies of writing code in R, preparing control streams in NONMEM, tracking models with Pirana, and executing them with PsN. The three of us spent countless hours sorting through NONMEM errors; we were occasionally joined by Francis, who had also recently completed his master’s degree. It took Suzan and I an extra year to master these skills.
Back then, only two computers in the department had the NONMEM software, which had been donated by ICON. Running models required being physically present in the lab, and the long run times meant we were often interrupted by power outages. I remember a time when Kuteesa was running a bootstrap that took over 24 hours. He started the process on a Friday, and when he checked on the model on Saturday morning everything seemed fine. But when we returned to the lab on Monday, we discovered that there had been a power outage, and the run was incomplete. He had to re-start the process. Suffice to say running models on a desktop computer was far from efficient.
Since those early days, we’ve all grown as pharmacometricians. (Dr. Owen and Dr. Ette returned to Uganda in 2016 and continued to give lectures that fuelled our passion for pharmacometrics. To this day, we remain in touch.) Kuteesa and I both went on to do internships at Novartis Pharma in Basel where we first met Prof Colin Pillai. Kuteesa later enrolled in a PhD program at Makerere University and co-founded Breakthrough Analytics with Dr Ette in 2015. Francis Ojara pursued his PhD at Freie University in Berlin, and I completed my PhD at the University of Cape Town. Both Francis and I then had the opportunity to work as postdocs at the Infectious Diseases Institute on the Maternal and Infant Lactation pharmacoKinetics (MILK) project. We’ve also since mentored other students, including Allan Kengo, who is completing his PhD at the University of Cape Town, and Ronald Kadada and Rashida Nakamyuka, whose masters projects were in pharmacometrics. Many of the pharmacometricians from our extended group in Uganda have completed advanced level training the Applied Pharmacometrics Training (APT) program.
In 2017, I had the privilege of discussing my aspirations for a PhD with Colin and Prof Paolo Denti, who had also begun running seminars to promote pharmacometrics training in Africa. These efforts eventually culminated in my involvement in the work of Pharmacometrics Africa, a not-for-profit organisation dedicated to developing quantitative skills across the continent. Since then, we continue to collaborate.
By 2021, the number of Ugandan pharmacometricians had continued to increase, and with Prof Pillai’s continued mentorship, we were able to lead a 12-week online course with Ugandan faculty. With continued growth came a need for a dedicated space to become an interactive ‘modelling group,’ and under Dr Mukonzo’s leadership, we are now hosted within the Department of Pharmacology, Makerere University.
I will always be grateful for Dr Mukonzo’s encouragement and generosity which created an environment in which experts like Dr. Owen and Dr. Ette could visit and teach, offering us the resources and freedom to explore this innovative field. In retrospect, I realise how incredibly fortunate we are to have such unwavering support. Moving forward, I am committed to providing the same level of support–and the hands-on mentorship I received from my senior colleagues–whenever I have the opportunity.
Dr. Aida Kawuma
Pharmacometrics Africa
Scientist, PumasAi