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1.
Travel Med Infect Dis ; 41: 102045, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33798743

RESUMO

Although the relationship between human mobility and global dissemination of antimicrobial resistance (AMR) is well established, there are important aspects regarding dynamics and character of this spread that have not been well described such as the decreasing time from emergence to global dissemination. In addition, AMR spread through migrants is increasingly being discussed and examined. We believe caution should be exercised to not overly focus on this population since we believe migrants play a minor role and there is a history of stigmatizing and blaming migrants for emerging infections and disease outbreaks. International travelers are proportionately much more likely to perpetuate AMR spread due to the vastly greater volume combined with the increasing efficiency and speed at which they travel. Research, infection prevention measures, and policy development are likely to have the greatest impact if focused on the international traveler rather than on migrant populations.

2.
Am J Trop Med Hyg ; 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33848260

RESUMO

Migrant and immigrant farmworkers are cornerstones to food security and production in many nations. In the United States, farmworkers have been disproportionately impacted by COVID-19. Because they are considered essential workers, vaccines may be made imminently available to them and offer an opportunity to reduce these COVID-19-related impacts. It is essential for a successful vaccination campaign to address the unique challenges arising from this workforce's inherently mobile nature and limited access to healthcare. Proposed strategies to overcome these challenges include ensuring farmworkers are prioritized in vaccine allocation and provided cost-free vaccines at convenient locations through partnerships among health authorities, community- and faith-based groups, and health centers with trusted community relationships. Further, a portable immunization record should be used, and coordination of care continued when a farmworker moves to a new geographic location. If implemented well, vaccinating farmworkers can reduce the COVID-19 disease burden among these essential workers, improve public health, and protect food and agriculture production.

3.
Am J Trop Med Hyg ; 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33684066

RESUMO

The price of certain antiparasitic drugs (e.g., albendazole and mebendazole) has dramatically increased since 2010. The effect of these rising prices on treatment costs and use of standard of care (SOC) drugs is unknown. To measure the impact of drug prices on overall outpatient cost and quality of care, we identified outpatient visits associated with ascariasis, hookworm, and trichuriasis infections from the 2010 to 2017 MarketScan Commercial Claims and Encounters and Multi-state Medicaid databases using Truven Health MarketScan Treatment Pathways. Evaluation was limited to members with continuous enrollment in non-capitated plans 30 days prior, and 90 days following, the first diagnosis. The utilization of SOC prescriptions was considered a marker for quality of care. The impact of drug price on the outpatient expenses was measured by comparing the changes in drug and nondrug outpatient payments per patient through Welch's two sample t-tests. The total outpatient payments per patient (drug and nondrug), for the three parasitic infections, increased between 2010 and 2017. The increase was driven primarily by prescription drug payments, which increased 20.6-137.0 times, as compared with nondrug outpatient payments, which increased 0.3-2.2 times. As prices of mebendazole and albendazole increased, a shift to alternative SOC and non-SOC drug utilization was observed. Using parasitic infection treatment as a model, increases in prescription drug prices can act as the primary driver of increasing outpatient care costs. Simultaneously, there was a shift to alternative SOC, but also to non-SOC drug treatment, suggesting a decrease in quality of care.

4.
Am J Trop Med Hyg ; 104(2): 433-435, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33534734

RESUMO

As COVID-19 vaccines are distributed across the United States, it is essential to address the pandemic's disproportionate impact on refugee, immigrant, and migrant (RIM) communities. Although the National Academies Press Framework for Equitable Allocation of COVID-19 Vaccine provides recommendations for an equitable vaccine campaign, implementation remains. Practical considerations for vaccine rollout include identifying and overcoming barriers to vaccination among RIM communities. To identify barriers, information regarding vaccine beliefs and practices must be incorporated into the pandemic response. To overcome barriers, effective communication, convenience of care, and community engagement are essential. Taking these actions now can improve health among RIM communities.


Assuntos
/administração & dosagem , Emigrantes e Imigrantes , Refugiados , Migrantes , /epidemiologia , Humanos , Estados Unidos , Vacinação/normas
6.
JAMA Netw Open ; 3(8): e2013595, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32804216

RESUMO

Importance: Some sole-source, off-patent drugs in the United States have undergone substantial price hikes in recent years. Despite increased attention by lawmakers, there are limited data to guide policy. Objectives: To describe key attributes of sole-source, off-patent, off-exclusivity drugs; to characterize the prevalence of price increases; and to identify attributes associated with price increases. Design, Setting, and Participants: In this cross-sectional study, 300 sole-source, off-patent, off-exclusivity drug products met inclusion criteria and were selected for analysis from January 1, 2008, to December 31, 2018. Attributes were identified from multiple sources, and yearly wholesale acquisition cost prices were determined from First Databank. Main Outcomes and Measures: The association of drug attributes with the following 2 price change thresholds was measured after adjusting for inflation: 25% or more price increase in a calendar year (wholesale acquisition cost) and 50% or more price increase in a calendar year. The rate of annual price increase over time was also measured. Results: Of the 300 drug products and 2242 observations analyzed, the overall inflation-adjusted mean increase in drug prices was 8.8% (95% CI, 7.8%-9.8%) per year. Ninety-five drugs (31.7%) increased by 25% or more during any calendar year, and 66 drugs (22.0%) increased by 50% or more during any calendar year. An initial price of less than $2 per unit (adjusted odds ratio [aOR], 2.36; 95% CI, 1.69-3.29), antineoplastic and immunomodulatory class (aOR, 2.72; 95% CI, 1.31-5.65), dermatologic class (aOR, 2.95; 95% CI, 1.80-4.84), oral route (aOR, 2.01; 95% CI, 1.45-2.79), and US Food and Drug Administration (FDA) approval before 1990 (aOR, 1.52; 95% CI, 1.14-2.03) were attributes of drugs that were more likely to be associated with a 25% or more price increase in a calendar year after adjusting for by initial price. Similarly, an initial price of less than $2 per unit (aOR, 2.68; 95% CI, 1.76-4.09), antineoplastic and immunomodulatory class (aOR, 3.07; 95% CI, 1.54-6.12), oral route of administration (aOR, 1.70; 95% CI, 1.11-2.60), and FDA approval before 1990 (aOR, 2.02; 95% CI, 1.40-2.94) were attributes of drugs that were more likely to be associated with a 50% or more price increase in a calendar year after adjusting for by initial price. Price increases of 25% or more were most common in 2014, and price increases of 50% or more were most common in 2013. Conclusions and Relevance: Price increases among sole-source, off-patent drugs are common, and policy interest in this practice is warranted. These findings should inform state drug pricing legislation.

8.
PLoS One ; 15(3): e0229565, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163426

RESUMO

BACKGROUND: Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and relatives (VFRs) experience a disproportionate burden of malaria illness. Various studies have explored barriers to malaria prevention among VFRs and non-VFRs-travelers to the same destinations with other purpose for travel-but few employed robust epidemiologic study designs or performed comparative analyses of these two groups. To better quantify the key barriers that VFRs face to implement effective malaria prevention measures, we conducted a comprehensive community-based, cross-sectional, survey to identify differences in malaria prevention knowledge, attitudes, and practices (KAP) among VFRs and others traveling to Africa and describe the differences between VFRs and other types of international travelers. METHODS AND FINDINGS: Three distinct populations of travelers with past or planned travel to malaria-endemic countries of SSA were surveyed: VFRs diagnosed with malaria as reported through a state health department; members of the general VFR population (community); and VFR and non-VFR travelers presenting to a travel health clinic, both before their pretravel consultation and again, after return from travel. A Community Advisory Board of African immigrants and prior qualitative research informed survey development and dissemination. Across the three groups, 489 travelers completed surveys: 351 VFRs and 138 non-VFRs. VFRs who reported taking antimalarials on their last trip rated their concern about malaria higher than those who did not. Having taken five or more trips to SSA was reported more commonly among VFRs diagnosed with malaria than community VFRs (44.0% versus 20.4%; p = 0.008). Among travel health clinic patients surveyed before and after travel, VFR travelers were less successful than non-VFRs in adhering to their planned use of antimalarials (82.2% versus 98.7%; p = 0.001) and employing mosquito bite avoidance techniques (e.g., using bed nets: 56.8% versus 81.8%; p = 0.009). VFRs who visited the travel health clinic were more likely than VFR respondents from the community to report taking an antimalarial (83.0% versus 61.9%; p = 0.009), or to report bite avoidance behaviors (e.g., staying indoors when mosquitoes were out: 80.9% versus 59.5%; p = 0.009). CONCLUSIONS: We observed heterogeneity in malaria prevention behaviors among VFRs and between VFR and non-VFR traveler populations. Although VFRs attending the travel health clinic appear to demonstrate better adherence to malaria prevention measures than VFR counterparts surveyed in the community, specialized pretravel care is not sufficient to ensure chemoprophylaxis use and bite avoidance behaviors among VFRs. Even when seeking specialized pretravel care, VFRs experience greater barriers to the use of malaria prevention than non-VFRs. Addressing access to health care and upstream barrier reduction strategies that make intended prevention more achievable, affordable, easier, and resonant among VFRs may improve malaria prevention intervention effectiveness.


Assuntos
Emigrantes e Imigrantes/psicologia , Malária/epidemiologia , Malária/prevenção & controle , Adulto , África ao Sul do Saara/epidemiologia , Antimaláricos/uso terapêutico , Atitude , Quimioprevenção/métodos , Quimioprevenção/tendências , Estudos Transversais , Família , Feminino , Amigos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Conhecimento , Masculino , Pessoa de Meia-Idade , Vigilância da População , Inquéritos e Questionários , Viagem/estatística & dados numéricos , Doença Relacionada a Viagens , Estados Unidos/epidemiologia
9.
PLoS Negl Trop Dis ; 13(4): e0007190, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30973876

RESUMO

A subset of anti-infective drugs are increasingly unavailable for patients in the United States due to pricing or withdrawal from the market. Timely market solutions are needed. We assert that solutions to ensure access to some essential anti-infective agents lie outside capital markets and that public-private partnerships may be the most viable solution.


Assuntos
Anti-Infecciosos/provisão & distribução , Doenças Transmissíveis/tratamento farmacológico , Indústria Farmacêutica/economia , Anti-Infecciosos/economia , Indústria Farmacêutica/legislação & jurisprudência , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/provisão & distribução , Setor Público , Estados Unidos , United States Food and Drug Administration
10.
J Travel Med ; 26(2)2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30602033

RESUMO

BACKGROUND: Over half of malaria cases reported in the USA occur among people travelling to visit friends and relatives (VFRs), predominantly to West Africa. Few studies have queried VFR travellers directly on barriers to seeking pre-travel care. We aim to describe the knowledge, attitudes and practices of VFRs travelling to malaria-endemic countries from the USA. With these findings, we aim to design interventions to encourage preventive behaviours before and during travel. METHODS: Sixteen focus groups were held in two US metropolitan areas with West African immigrant populations: Minneapolis-St. Paul, MN, and New York City, NY. A total of 172 people from 13 African countries participated. Focus group discussions were audio-recorded and transcribed, and modified grounded theory analysis was performed. Participants reviewed themes to verify intent of statements. RESULTS: Participants described the high cost of provider visits and chemoprophylaxis, challenges in advocating for themselves in healthcare settings and concerns about offending or inconveniencing hosts as barriers to malaria prevention. Cultural barriers to accessing pre-travel care included competing priorities when trip planning, such as purchasing gifts for family, travel logistics and safety concerns. When participants sought pre-travel care, most consulted their primary care provider. Participants expressed low confidence in US providers' knowledge and training about malaria and other tropical diseases. CONCLUSION: Barriers to pre-travel care for VFR travellers are multifaceted and extend beyond their perception of disease risk. Only some barriers previously reported in anecdotal and qualitative literature were supported in our findings. Future interventions should be aimed at barriers identified by individual communities and involve primary and travel specialist healthcare providers. Additional work is needed to address systems-level barriers to accessing care and establishing community-based programs to support West African VFR traveller health.


Assuntos
Antimaláricos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Malária/prevenção & controle , Viagem , Adolescente , Adulto , África Ocidental , Idoso , Idoso de 80 Anos ou mais , Quimioprevenção , Características Culturais , Feminino , Grupos Focais , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Medicina de Viagem , Estados Unidos , Adulto Jovem
12.
Am J Trop Med Hyg ; 99(4): 978-986, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30062987

RESUMO

Although immigrants who visit friends and relatives (VFRs) account for most of the travel-acquired malaria cases in the United States, there is limited evidence on community-level risk factors and best practices for prevention appropriate for various VFR groups. Using 2010-2014 malaria case reports, sociodemographic census data, and health services data, we explored and mapped community-level characteristics to understand who is at risk and where imported malaria infections occur in Minnesota. We examined associations with malaria incidence using Poisson and negative binomial regression. Overall, mean incidence was 0.4 cases per 1,000 sub-Saharan African (SSA)-born in communities reporting malaria, with cases concentrated in two areas of Minneapolis-St. Paul. We found moderate and positive associations between imported malaria and counts of SSA- and Asian-born populations, respectively. Our findings may inform future studies to understand the knowledge, attitudes, and practices of VFR travelers and facilitate and focus intervention strategies to reduce imported malaria in the United States.


Assuntos
Emigrantes e Imigrantes , Conhecimentos, Atitudes e Prática em Saúde , Malária Falciparum/epidemiologia , Malária Falciparum/prevenção & controle , Plasmodium falciparum/isolamento & purificação , Viagem/estatística & dados numéricos , Adolescente , Adulto , África ao Sul do Saara/epidemiologia , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Incidência , Malária Falciparum/diagnóstico , Malária Falciparum/parasitologia , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Medição de Risco
13.
Emerg Infect Dis ; 24(8)2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30014834

RESUMO

During 2012-2015, US-bound refugees living in Myanmar-Thailand border camps (n = 1,839) were surveyed for hookworm infection and treatment response by using quantitative PCR. Samples were collected at 3 time points: after each of 2 treatments with albendazole and after resettlement in the United States. Baseline prevalence of Necator americanus hookworm was 25.4%, Ancylostoma duodenale 0%, and Ancylostoma ceylanicum (a zoonosis) 5.4%. Compared with N. americanus prevalence, A. ceylanicum hookworm prevalence peaked in younger age groups, and blood eosinophil concentrations during A. ceylanicum infection were higher than those for N. americanus infection. Female sex was associated with a lower risk for either hookworm infection. Cure rates after 1 dose of albendazole were greater for A. ceylanicum (93.3%) than N. americanus (65.9%) hookworm (p<0.001). Lower N. americanus hookworm cure rates were unrelated to ß-tubulin single-nucleotide polymorphisms at codons 200 or 167. A. ceylanicum hookworm infection might be more common in humans than previously recognized.


Assuntos
Ancylostoma/isolamento & purificação , Ancilostomíase/epidemiologia , Ancilostomíase/parasitologia , Refugiados , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/uso terapêutico , Ancilostomíase/tratamento farmacológico , Animais , Anti-Helmínticos/uso terapêutico , Criança , Pré-Escolar , Fezes/parasitologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Tailândia/epidemiologia , Adulto Jovem
15.
J Immigr Minor Health ; 20(2): 334-338, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28474198

RESUMO

Histoplasmosis is known to be endemic to the Midwestern United States, but cases have been reported throughout much of the world. Somali, Hmong, and Burmese (ethnically Karen) persons make up some of the largest refugee populations coming the United States in recent years. Yet, information about risk of Histoplasma capsulatum infection amongst these populations is limited. This study used the CDC Migrant Serum Bank to test ~100 samples from each of Somali, Burmese, and Hmong U.S.-bound refugees. Samples were tested by enzyme immunoassay for Histoplasma capsulatum IgG. Overall 1% (2/299) of refugee serum samples were positive for H. capsulatum IgG. One of 99 samples obtained from Hmong refugees was positive, and the other positive sample came from among 100 Burmese refugee samples. H capsulatum IgG positivity was detected at low levels in Hmong and Burmese refugees. No IgG positivity was detected among 100 Somali refugees.


Assuntos
Histoplasmose/etnologia , Refugiados/estatística & dados numéricos , Adulto , Feminino , Humanos , Quênia/epidemiologia , Laos/etnologia , Masculino , Pessoa de Meia-Idade , Mianmar/etnologia , Campos de Refugiados , Estudos Soroepidemiológicos , Somália/etnologia , Tailândia/epidemiologia , Adulto Jovem
16.
J Correct Health Care ; 24(1): 84-95, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28945148

RESUMO

U.S. Immigration and Customs Enforcement (ICE) is responsible for detaining unauthorized aliens during immigration proceedings. During 2014 to 2015, adult ICE detainees at a California facility were invited to complete a survey concerning self-reported varicella history and risk factors. Participants underwent serological testing for varicella-zoster virus (VZV) IgG; susceptible individuals were offered varicella vaccination. Among 400 detainees with available serology results, 48 (12%) were susceptible to varicella. Self-reported varicella history was negatively associated with susceptibility (adjusted odds ratio = 0.16; 95% confidence interval [0.07, 0.35]). Among 196 detainees reporting a positive history, 95% had VZV IgG levels suggestive of varicella immunity. Among 44 susceptible detainees offered vaccination, 86% accepted. Given relatively high varicella susceptibility, targeted screening and vaccination among ICE detainees lacking a positive history might reduce varicella transmission risks.


Assuntos
Imigrantes Indocumentados/estatística & dados numéricos , Infecção pelo Vírus da Varicela-Zoster/etnologia , Adulto , California , Feminino , Herpesvirus Humano 3 , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Vacinação/estatística & dados numéricos , Adulto Jovem
17.
Am J Trop Med Hyg ; 98(3): 920-928, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29260657

RESUMO

With an unprecedented number of displaced persons worldwide, strategies for improving the health of migrating populations are critical. United States-bound refugees undergo a required overseas medical examination to identify inadmissible conditions (e.g., tuberculosis) 2-6 months before resettlement, but it is limited in scope and may miss important, preventable infectious, chronic, or nutritional causes of morbidity. We sought to evaluate the feasibility and health impact of diagnosis and management of such conditions before travel. We offered voluntary testing for intestinal parasites, anemia, and hepatitis B virus infection, to U.S.-bound refugees from three Thailand-Burma border camps. Treatment and preventive measures (e.g., anemia and parasite treatment, vaccination) were initiated before resettlement. United States refugee health partners received overseas results and provided post-arrival medical examination findings. During July 9, 2012 to November 29, 2013, 2,004 refugees aged 0.5-89 years enrolled. Among 463 participants screened for seven intestinal parasites overseas and after arrival, helminthic infections decreased from 67% to 12%. Among 118 with positive Strongyloides-specific antibody responses, the median fluorescent intensity decreased by an average of 81% after treatment. The prevalence of moderate-to-severe anemia (hemoglobin < 10 g/dL) was halved from 14% at baseline to 7% at departure (McNemar P = 0.001). All 191 (10%) hepatitis B-infected participants received counseling and evaluation; uninfected participants were offered vaccination. This evaluation demonstrates that targeted screening, treatment, and prevention services can be conducted during the migration process to improve the health of refugees before resettlement. With more than 250 million migrants globally, this model may offer insights into healthier migration strategies.


Assuntos
Infecções Bacterianas/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Enteropatias Parasitárias/prevenção & controle , Programas de Rastreamento/organização & administração , Refugiados , Viroses/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Enteropatias Parasitárias/diagnóstico , Masculino , Pessoa de Meia-Idade , Mianmar , Tailândia , Estados Unidos , Vacinação/estatística & dados numéricos , Viroses/diagnóstico
18.
Emerg Infect Dis ; 23(12): 2095-2097, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29148387

RESUMO

The knowledge, attitudes, and practices surrounding bushmeat consumption and importation in the United States are not well described. Focus groups of West African persons living in Minnesota, USA, found that perceived risks are low and unlikely to deter consumers. Incentives for importation and consumption were multifactorial in this community.


Assuntos
Emigrantes e Imigrantes/psicologia , Comportamento Alimentar/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Carne , Adolescente , Adulto , África Ocidental , Animais , Animais Selvagens , Carnívoros , Quirópteros , Comportamento Alimentar/etnologia , Feminino , Humanos , Masculino , Minnesota/etnologia , Primatas , Roedores , Estigma Social
19.
Clin Infect Dis ; 65(11): 1848-1852, 2017 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-29020146

RESUMO

Background: In recent years, the price of many older generic drugs, including numerous antibiotics, has increased substantially. We sought to analyze recent price changes and extent of generic competition within a cohort of commonly prescribed off-patent oral antibiotics. Methods: We extracted oral antibiotics recommended for common outpatient conditions in the Infectious Diseases Society of America Practice Guidelines. We determined all US Food and Drug Administration-approved manufacturers for each formulation and strength in 2013 and 2016 and the yearly national average drug acquisition cost (NADAC) price between 2013 and 2016. Wilcoxon signed rank test was used to compare changes in drug prices and number of manufacturers from 2013 to 2016. Spearman correlation coefficient was used to assess the association between drug prices and number of manufacturers. Results: Twenty-two antibiotics (81 formulations and strengths) were analyzed. There was no change in the median NADAC price or the number of manufacturers between 2013 and 2016. However, 11 (14%) formulations increased in price by 90% or more, and 13 (16%) had 2 or fewer manufacturers during all 4 years. Antibiotic prices were negatively associated with the number of available manufacturers. Conclusions: While prices and the number of manufacturers for common oral antibiotics were overall stable between 2013 and 2016, reduced manufacturer competition was associated with increased prices. A subset of antibiotics exhibited substantial price increases, and most, but not all, had limited manufacturer competition. Policy solutions are needed to ensure availability of low-cost, essential generic antibiotics.


Assuntos
Antibacterianos , Custos de Medicamentos , Medicamentos Genéricos , Administração Oral , Custos e Análise de Custo , Indústria Farmacêutica , Competição Econômica , Humanos , Estados Unidos , United States Food and Drug Administration
20.
PLoS Negl Trop Dis ; 11(9): e0005794, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28910299

RESUMO

Drugs for neglected tropical diseases (NTD) are being excessively priced in the United States. Benznidazole, the first-line drug for Chagas disease, may become approved by the Food and Drug Administration (FDA) and manufactured by a private company in the US, thus placing it at risk of similar pricing. Chagas disease is an NTD caused by Trypanosoma cruzi; it is endemic to Latin America, infecting 8 million individuals. Human migration has changed the epidemiology causing nonendemic countries to face increased challenges in diagnosing and managing patients with Chagas disease. Only 2 drugs exist with proven efficacy: benznidazole and nifurtimox. Benznidazole has historically faced supply problems and drug shortages, limiting accessibility. In the US, it is currently only available under an investigational new drug (IND) protocol from the CDC and is provided free of charge to patients. However, 2 companies have stated that they intend to submit a New Drug Application (NDA) for FDA approval. Based on recent history of companies acquiring licensing rights for NTD drugs in the US with limited availability, it is likely that benznidazole will become excessively priced by the manufacturer-paradoxically making it less accessible. However, if the companies can be taken at their word, there may be reason for optimism.


Assuntos
Doença de Chagas/tratamento farmacológico , Nitroimidazóis/economia , Nitroimidazóis/provisão & distribução , Tripanossomicidas/economia , Tripanossomicidas/provisão & distribução , Centers for Disease Control and Prevention, U.S. , Doença de Chagas/epidemiologia , Custos de Medicamentos , Drogas em Investigação/economia , Humanos , Nifurtimox/uso terapêutico , Nitroimidazóis/uso terapêutico , Tripanossomicidas/uso terapêutico , Estados Unidos , United States Food and Drug Administration
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