Establishing comprehensive oncology-haematology pharmacy care for paediatric bone marrow transplantation in sickle cell disease: Procedural insights from a Delphi study conducted in Tanzania

BackgroundHematopoietic stem cell transplantation (HSCT) is vital for treating blood disorders, yet Low- and Middle-Income Countries (LMICs) often lack adequate Bone Marrow Transplant (BMT) pharmacy services. This study aims to reach consensus among oncology pharmacy experts on the essential staff, infrastructure, supplies, and safety/control measures required to establish BMT pharmacy services in LMICs.MethodologyThe Delphi method was employed to evaluate and achieve consensus on BMT pharmacy services at Benjamin Mkapa Hospital in Tanzania, involving 11 oncology pharmacy personnel.ResultsIn the initial round, participants responded to 10 open-ended questions concerning staffing, infrastructure, supplies, medicines, safety, and quality assurance. The second round focused on achieving consensus, breaking down the domains into 14 specific points. Consensus scores varied from 64% (neutral) for safety and quality assurance to 96% for staffing levels, with consensus reached at 66.7%. The third round concentrated on prioritization, identifying staffing and infrastructure as high priorities, which received a score of 46%. Safety and quality assurance garnered the lowest score at 9%. Participants proposed two guidelines, three protocols, and 21 standard operating procedures (SOPs). Additionally, they suggested 14 essential medicines, 56 adjunctive medicines, 22 medical devices, and at least two Class III biosafety cabinets, which are crucial for establishing BMT pharmacy units and HSCT services in resource-limited settings. These resources were categorized into those already established at BMH and those that emerged from participant consensus.ConclusionsThe Delphi findings highlight staffing and infrastructure as top priorities for establishing BMT and HSCT services in resource-limited settings. Addressing safety and quality assurance is also crucial. The recommended guidelines and protocols can enhance service delivery and improve patient outcomes.