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1.
Pan Afr Med J ; 35(Suppl 2): 149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193964

RESUMO

HIV/AIDS is an infectious disease that has claimed the lives of millions of people worldwide. Currently, there is no vaccine that has been developed in a bid to fight this deadly infection, however, antiretrovirals (ARVs), which are drugs used in the treatment of HIV infection are routinely prescribed to infected persons. They act via several mechanisms of action to reduce the severity of infection and rate of infectivity of the virus by decreasing the viral load while increasing CD4 counts. COVID-19 pandemic has resulted in unprecedented events affecting almost all areas of humans' life including availability of medicines and other consumables. This paper analyses the availability of ARVs during COVID-19 era and offered recommendations to be adopted in order to prevent shortages.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Reposicionamento de Medicamentos , Infecções por HIV/tratamento farmacológico , Pandemias , Pneumonia Viral/tratamento farmacológico , Fármacos Anti-HIV/economia , Fármacos Anti-HIV/provisão & distribução , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/economia , Antirretrovirais/provisão & distribução , Terapia Antirretroviral de Alta Atividade/economia , Betacoronavirus , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento , Custos de Medicamentos/tendências , Indústria Farmacêutica , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Seguro de Serviços Farmacêuticos , Adesão à Medicação , Nigéria/epidemiologia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Carga Viral/efeitos dos fármacos
3.
WHO South East Asia J Public Health ; 9(2): 126-133, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32978345

RESUMO

Most people living with HIV in low- and middle-income countries are treated with generic antiretroviral (ARV) drugs produced by manufacturers in India - the "pharmacy of the developing world". India's nationwide lockdown in March 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic therefore prompted concerns about disruption to this essential supply. A preliminary assessment of ARV drug manufacturers in India in March 2020 indicated a range of concerns. This prompted a rapid questionnaire-based survey in May 2020 of eight manufacturers that account for most of India's ARV drug exports. The greatest challenges reported were in international shipping, including delays, increased lead times and rising costs. Contrary to expectations, lack of access to the active pharmaceutical ingredients (APIs) required for ARV drug manufacture was not a major hindrance, as manufacturers reported that their reliance on China for API supplies had reduced in recent years. However, their reliance on overseas markets for the raw materials required for local API synthesis was a major challenge. The findings from this survey have implications for addressing some of the immediate and medium-term concerns about the production and supply of generic ARV drugs. Long-term orders to support multi-month dispensing and buffer stocks need to be in place, together with computerized inventory management systems with real-time information from the lowest-level dispensation unit. Manufacturers and industry associations should have regular, formal interaction with the key ministries of the Government of India regarding these issues. Measures to improve the resilience of the generic ARV drug supply system are essential to minimize ongoing supply shocks resulting from the COVID-19 pandemic and to prepare for future emergencies.


Assuntos
Antirretrovirais/provisão & distribução , Infecções por Coronavirus/epidemiologia , Indústria Farmacêutica , Pneumonia Viral/epidemiologia , Infecções por HIV/tratamento farmacológico , Humanos , Índia/epidemiologia , Pandemias , Inquéritos e Questionários
4.
PLoS One ; 15(4): e0230451, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32287264

RESUMO

INTRODUCTION: With the scale-up of antiretroviral therapy (ART) there is a need to monitor programme performance to maximize ART efficacy and to prevent emergence of HIV drug resistance (HIVDR). In keeping with the elements of the World Health Organisation (WHO) guidance we carried out a nationally representative assessment of early warning indicators (EWI) at 304 randomly selected ART service outlets in Uganda. METHODS: Retrospective patient data was extracted for the six EWIs for HIVDR including; on-time antiretroviral (ARV) drug pick-up, patient retention on ART at 12 months, ART dispensing practices, ARV drug stock-outs, viral load suppression (VLS) and viral load (VL) testing completion. Point prevalence for each clinic and national aggregate prevalence with 95% confidence intervals (CI) for all clinics were estimated and facility performances were computed and association between EWIs and programmatic factors assessed using Fisher's Exact Test. RESULTS: Facilities meeting the EWI targets: on-time pill pick-up was 9.5%, more facilities in the north met this target (p = 0.040). Retention on ART at 12 months was 24.1%, facilities in Kampala region (p<0.001) and Specialized ART clinics (p = 0.01) performed better in this indicator. Pharmacy stock-outs was 33.6%, with more facilities in Kampala (p<0.001), specialized ART clinics (p<0.001) and private-for-profit (p<0.001) meeting this target. Dispensing practices was met by 100% of the facilities. VLS was met by 49.2% and 50.8% of facilities met VL completion target with facilities in central region performing better (p<0.001). National prevalence for the EWIs was: on-time pill pick-up 63.3% (CI: 58.9-67.8); retention on ART at 12 months 69.9% (CI: 63.8-76.0); dispensing practices 100.0%; VLS 85.2% (CI: 81.8-88.5) and VL completion, 60.7% (CI: 56.9-64.6). CONCLUSION: Dispensing practices in all facilities were in line with the national guidelines however, there still remains a challenge to long-term ART programmatic success in monitoring patient response to treatment, and maintaining patients on ART without interruptions arising due to poor patient adherence and as a consequence of ARV supply interruption. It is therefore of high importance that the national ART program ensures intensified follow-up for patients, ensuring uninterrupted supply of ARV drugs and increasing VL monitoring at treatment centres, in order to improve patient outcomes and avert preventable HIVDR.


Assuntos
Antirretrovirais/provisão & distribução , Infecções por HIV/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Adulto , Antirretrovirais/uso terapêutico , Farmacorresistência Viral , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários , Uganda , Carga Viral , Organização Mundial da Saúde
5.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(5): 662-666, 2020 May 10.
Artigo em Chinês | MEDLINE | ID: mdl-32223840

RESUMO

Objective: To collect the current status and healthcare needs of people living with HIV (PLHIV) in China during the COVID-19 outbreak to inform quick response from government and communities. Methods: During February 5(th) to 10(th), 2020, a national anonymous survey was conducted using an online questionnaire among PLHIV at least 18 years of age and had started antiretroviral treatment (ART) to collect the information on COVID-19 prevention, HIV-related health services and the needs on psychosocial support. Current status and needs of people living with HIV were analyzed in Hubei and other regions. Results: A total of 1 014 valid questionnaires were collected, with PLHIV respondents cross the country. The survey revealed that 93.79% of the respondents could obtain information regarding the prevention of COVID-19 from their communities or villages. Respondents were concerned with HIV-specific protective measures and personal protective equipment shortage. 32.64% of all respondents were not carrying sufficient antiretroviral medicines (ARVs) to meet the needs under traffic and travel restrictions, and some could face stock-outs in the coming month. In Hubei province where 53 respondents needed ARV refill, 64.15% reported difficulty accessing ARV due to the "blockage" . 28.93% respondents were in need of sociopsychological support, and 85.31% anticipated further improvement of the out-of-town ARV refill process from the government. Conclusion: PLHIV wants to know HIV-specific protective measures against COVID-19 outbreak. PLHIV who returned to their home-towns and affected by the lock-downs reported challenges with refills. We should undertake a more systematic study on impacts of the COVID-19 on PLHIV to develop preparedness capacity for future public health emergency.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Infecções por HIV/terapia , Pneumonia Viral/epidemiologia , Antirretrovirais/provisão & distribução , China/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Pandemias , Inquéritos e Questionários
7.
Afr J AIDS Res ; 18(4): 315-323, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31779572

RESUMO

The rapid scale-up of antiretroviral treatment (ART) for HIV since the mid-2000s, mostly through disease-specific or "vertical" programmes, has been a highly successful undertaking, which averted millions of deaths and prevented many new infections. However, the dynamics of the HIV epidemic and changing political and financial commitment to fight the disease will likely require new models for the delivery of ART over the coming decades if the promises of universal treatment are to be met. Delivery model innovations for ART are intended to improve both the effectiveness and efficiency of the HIV treatment cascade, reaching new people who require ART and providing ART to more people without an increase in resources. We describe twelve models for ART delivery, which could be achieved through five categories of delivery innovations: integrating ART ("vertical ART plus", "partially-integrated ART" and "fully-integrated ART"); modifying steps in the ART value chain ("professional task-shifted ART", "people task-shifted ART" and "technology-supported ART"); eliminating steps in the ART value chain ("immediate ART" and "less frequent ART pick-up"); changing ART locations ("private-sector ART", "traditional-sector ART" and "ART outside the health sector"); and keeping the status quo ("vertical ART"). The different delivery model innovations are not mutually exclusive and several could be combined, such as "vertical ART plus" with "task-shifted ART". Suitability of the models will highly depend on local and national contexts, including existing health systems resources, available funding, and type of HIV epidemic. Future implementation research needs to identify which models are the best fit for different contexts.


Assuntos
Antirretrovirais/uso terapêutico , Assistência à Saúde/métodos , Infecções por HIV/tratamento farmacológico , Modelos Teóricos , Antirretrovirais/provisão & distribução , Humanos , Avaliação de Programas e Projetos de Saúde
8.
Health Policy Plan ; 34(8): 559-565, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31408152

RESUMO

High quality of care (QoC) for antiretroviral treatment (ART) is essential to prevent treatment failure. Uganda, as many sub-Saharan African countries, increased access to ART by decentralizing provision to districts. However, little is known whether this rapid scale-up maintained high-quality clinical services. We assess the quality of ART in the Acholi and Lango sub-regions of northern Uganda to identify whether the technical quality of critical ART sub-system needs improvement. We conducted a randomized cross-sectional survey among health facilities (HF) in Acholi (n = 11) and Lango (n = 10). Applying lot quality assurance sampling principles with a rapid health facility assessment tool, we assessed ART services vis-à-vis national treatment guidelines using 37 indicators. We interviewed health workers (n = 21) using structured questionnaires, directly observed clinical consultations (n = 126) and assessed HF infrastructure, human resources, medical supplies and patient records in each health facility (n = 21). The district QoC performance standard was 80% of HF had to comply with each guideline. Neither sub-region complied with treatment guidelines. No HF displayed adequate: patient monitoring, physical examination, training, supervision and regular monitoring of patients' immunology. The full range of first and second line antiretroviral (ARV) medication was not available in Acholi while Lango had sufficient stocks. Clinicians dispensed available ARVs without benefit of physical examination or immunological monitoring. Patients reported compliance with drug use (>80%). Patients' knowledge of preventing HIV/AIDS transmission concentrated on condom use; otherwise it was poor. The poor ART QoC in northern Uganda raises major questions about ART quality although ARVs were dispensed. Poor clinical care renders patients' reports of treatment compliance as insufficient evidence that it takes place. Further studies need to test patients' immunological status and QoC in more regions of Uganda and elsewhere in sub-Saharan Africa to identify topical and geographical areas which are priorities for improving HIV care.


Assuntos
Antirretrovirais/administração & dosagem , Infecções por HIV/tratamento farmacológico , Qualidade da Assistência à Saúde/estatística & dados numéricos , Antirretrovirais/provisão & distribução , Antirretrovirais/uso terapêutico , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Instalações de Saúde/normas , Pessoal de Saúde , Humanos , Amostragem para Garantia da Qualidade de Lotes , Cooperação do Paciente , Inquéritos e Questionários , Uganda
9.
Infect Dis Poverty ; 8(1): 63, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31370888

RESUMO

BACKGROUND: Over 90% of Human Immunodeficiency Virus (HIV) infected individuals will be on treatment by 2020 under UNAIDS 90-90-90 global targets. Under World Health Organisation (WHO) "Treat All" approach, this number will be approximately 36.4 million people with over 98% in low-income countries (LICs). MAIN BODY: Pretreatment drug resistance (PDR) largely driven by frequently use of non-nucleoside reverse transcriptase inhibitors (NNRTIs), efavirenz and nevirapine, has been increasing with roll-out of combined antiretroviral therapy (cART) with 29% annual increase in some LICs countries. PDR has exceeded 10% in most LICs which warrants change of first line regimen to more robust classes under WHO recommendations. If no change in regimens is enforced in LICs, it's estimated that over 16% of total deaths, 9% of new infections, and 8% of total cART costs will be contributed by HIV drug resistance by 2030. Less than optimal adherence, and adverse side effects associated with currently available drug regimens, all pose a great threat to achievement of 90% viral suppression and elimination of AIDS as a public health threat by 2030. This calls for urgent introduction of policies that advocate for voluntary and compulsory drug licensing of new more potent drugs which should also emphasize universal access of these drugs to all individuals worldwide. CONCLUSIONS: The achievement of United Nations Programme on HIV and AIDS 2020 and 2030 targets in LICs depends on access to active cART with higher genetic barrier to drug resistance, better safety, and tolerability profiles. It's also imperative to strengthen quality service delivery in terms of retention of patients to treatment, support for adherence to cART, patient follow up and adequate drug stocks to help achieve a free AIDS generation.


Assuntos
Síndrome de Imunodeficiência Adquirida/prevenção & controle , Antirretrovirais/análise , Países em Desenvolvimento/estatística & dados numéricos , Desenvolvimento de Medicamentos , Antirretrovirais/provisão & distribução , Antirretrovirais/uso terapêutico , Farmacorresistência Viral , Humanos
10.
Glob Health Sci Pract ; 7(2): 300-316, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31249025

RESUMO

BACKGROUND: While measuring, monitoring, and improving supply chain management (SCM) for antiretrovirals (ARVs) is understood at many levels of health systems, a gap remains in the identification and measurement of facility-level practices and behaviors that affect SCM. This study identifies practices and behaviors that are associated with SCM of ARVs at the hospital level and proposes new indicators for measurement. METHODS: We performed an in-depth literature review to identify facility-level practices and behaviors and existing indicators that are associated with SCM. We used the United States Agency for International Development's 2013 National Supply Chain Assessment Toolkit to define 7 supply chain function areas to frame the study. Qualitative, semistructured key informant and focus group interviews were conducted in hospitals with health professionals from Cameroon, Namibia, and Swaziland to understand facility-level practices and behaviors. RESULTS: Using the results from 54 key informant and focus group interviews from 12 hospitals, we identified 30 practices and behaviors that may affect ARV SCM at the facility level. The following practice areas were particularly associated with SCM: order verification, actions taken when ARV stock is received, changes in prescription and dispensing due to ARV stock-out, actions to ensure patient adherence, and communication with other affiliated facilities and higher-level SCM. We subsequently developed measurable indicators for future research. CONCLUSION: This study characterizes facility-level practices and behaviors that can affect ARV SCM. It also identifies gaps in their measurement. While this study uses ARVs as a tracer medicine to understand gaps in practices at the facility level, many of the findings are more broadly applicable to other medicines in an integrated setting. This study provides real-world evidence and the groundwork for further research to characterize the link between 30 facility-level practices and behaviors and ARV SCM at the facility and central levels.


Assuntos
Fármacos Anti-HIV/provisão & distribução , Assistência à Saúde , Infecções por HIV/tratamento farmacológico , Hospitais , Administração de Materiais no Hospital , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/provisão & distribução , Antirretrovirais/uso terapêutico , Camarões , Essuatíni , Grupos Focais , Instalações de Saúde , Humanos , Namíbia
11.
J Assoc Nurses AIDS Care ; 30(5): e132-e143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31135515

RESUMO

Emerging HIV treatment distribution models across sub-Saharan Africa seek to overcome barriers to attaining antiretroviral therapy and to strengthen adherence in people living with HIV. We describe enablers, barriers, and benefits of differentiated treatment distribution models in South Africa, Uganda, and Zimbabwe. Data collection included semistructured interviews and focus group discussions with 163 stakeholders from policy, program, and patient levels. Four types of facility-based and 3 types of community-based models were identified. Enablers included policy, leadership, and guidance; functional information systems; strong care linkages; steady drug supply; patient education; and peer support. Barriers included insufficient drug supply, stigma, discrimination, and poor care linkages. Benefits included perceived improved adherence, peer support, reduced stigma and discrimination, increased time for providers to spend with complex patients, and travel and cost savings for patients. Differentiated treatment distribution models can enhance treatment access for patients who are clinically stable.


Assuntos
Fármacos Anti-HIV/provisão & distribução , Antirretrovirais/provisão & distribução , Terapia Antirretroviral de Alta Atividade/métodos , Serviços de Saúde Comunitária/organização & administração , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Assistência Centrada no Paciente , Estigma Social , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Feminino , Grupos Focais , Infecções por HIV/psicologia , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Adesão à Medicação/estatística & dados numéricos , Equipe de Assistência ao Paciente , Desenvolvimento de Programas , Pesquisa Qualitativa , Capital Social , África do Sul , Uganda , Zimbábue
12.
BMC Health Serv Res ; 19(1): 312, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092245

RESUMO

BACKGROUND: Despite the increasing frequency of ARV medicines stock-outs in Sub-Saharan Africa, there is little research inquiring into the mitigation strategies devised by frontline health facilities. Many previous studies have focused on 'upstream' or national-level drivers of ARVs stock-outs with less empirical attention devoted 'down-stream' or at the facility-level. The objective of this study was to examine the strategies devised by health facilities in Uganda to respond to the chronic stock-outs of ARVs. METHODS: This was a qualitative research design nested within a larger mixed-methods study. We purposively selected 16 health facilities from across Uganda (to achieve diversity with regard to; level of care (primary/ tertiary), setting (rural/urban) and geographic sub-region (northern/ central/western). We conducted 76 Semi-structured interviews with ART clinic managers, clinicians and pharmacists in the selected health facilities supplemented by on-site observations and documentary reviews. Data were analyzed by coding and thematic analyses. RESULTS: Participants reported that facility-level contributors to stock-outs include untimely orders of drugs from suppliers and inaccurate quantification of ARV medicine needs due to a paucity of ART program data. Internal stock management solutions for mitigating stock-outs which emerged include the substitution of ARV medicines which were out of stock, overstocking selected medicines and the use of recently expired drugs. The external solutions for mitigating stock-outs which were identified include 'borrowing' of ARVs from peer-providers, re-distributing stock across regions and upward referrals of patients. Systemic drivers of stock-outs were identified. These include the supply of drugs with a short shelf life, oversupply and undersupply of ARV medicines and migration pressures on the available ARVs stock at case-study facilities. CONCLUSION: Health facilities devised internal stock management strategies and relied on peer-provider networks for ARV medicines during stock-out events. Our study underscores the importance of devising interventions aimed at improving Uganda's medicines supply chain systems in the quest to reduce the frequency of ARV medicines stock-outs at the front-line level of service delivery. Further research is recommended on the effect of substituting ARV medicines on patient outcomes.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Antirretrovirais/provisão & distribução , Infecções por HIV/tratamento farmacológico , Antirretrovirais/uso terapêutico , Recursos em Saúde , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Uganda
13.
Inquiry ; 56: 46958019847020, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31064261

RESUMO

Yemen has witnessed a significant rise in AIDS-related deaths because of very poor access to antiretroviral treatment and because of the current war situation. This study aimed to assess the attributes of human immunodeficiency virus (HIV) reporting form, including usefulness, simplicity, flexibility, and acceptability, which is used for reporting HIV cases in Sana'a, Yemen. A descriptive cross-sectional study was conducted among 311 physicians from public and private health facilities in Sana'a city. Physicians were interviewed using a structured questionnaire to assess the form's attributes. The mean score was calculated for each attribute and converted to percentages which were interpreted as very poor, poor, average, good, and excellent. The usefulness overall score was 76%, indicating average usefulness. Of the total participants, 283 (91%) and 304 (97.7%) stated that the form is clear and easy to fill, respectively. More than two-thirds (68.5%) of physicians stated that the form ensures the privacy of the customer's identity. The simplicity attribute score was 74.5%, indicating average simplicity. The overall flexibility was 69.2%, indicating average flexibility. A total of 175 (56%) physicians indicated that they are completely satisfied with the reporting form. The acceptability score was 75.2%, indicating that the HIV/AIDS reporting form of HIV is average in acceptability. The HIV/AIDS reporting form in Yemen was scored average in usefulness, simplicity, flexibility, and acceptability. Training health workers on using the reporting form would improve the performance of HIV/AIDS reporting. Moreover, the reporting form could be adapted to be integrated with other surveillance such as tuberculosis surveillance.


Assuntos
Notificação de Doenças/métodos , Infecções por HIV/epidemiologia , Médicos , Inquéritos e Questionários/estatística & dados numéricos , Antirretrovirais/provisão & distribução , Estudos Transversais , Infecções por HIV/mortalidade , Humanos , Entrevistas como Assunto , Iêmen/epidemiologia
14.
Glob Health Action ; 12(1): 1586317, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30983547

RESUMO

BACKGROUND: Increased coverage with antiretroviral therapy for people living with HIV in low- and middle-income countries has increased their life expectancy associated with non-HIV comorbidities and the need for quality-assured and affordable non-communicable diseases drugs . Funders are leaving many middle-income countries that will have to pay and provide quality-assured and affordable HIV and non-HIV drugs, including for non-communicable diseases. OBJECTIVE: To estimate costs for originator and generic antiretroviral therapy as the number of people living with HIV are projected to increase between 2016 and 2026, and discuss country, regional and global factors associated with increased access to generic drugs. METHODS: Based on estimates of annual demand and prices, annual cost estimates were produced for generic and originator antiretroviral drug prices in low- and middle-income countries and projected for 2016-2026. RESULTS: Drug costs varied between US$1.5 billion and US$4.8 billion for generic drugs and US$ 8.2 billion and US$16.5 billion for originator drugs between 2016 and 2026. DISCUSSION: The global HIV response increased access to affordable generic drugs in low- and middle-income countries. Cheaper active pharmaceutical ingredients and market competition were responsible for reduced drug costs. The development and implementation of regulatory changes at country, regional and global levels, covering intellectual property rights and public health, and flexibilities in patent laws enabled prices to be reduced. These changes have not yet been applied in many low- and middle-income countries for HIV, nor for other infectious and non-communicable diseases, that lack the profile and political attention of HIV. Licensing backed up with Trade-Related Aspects of Intellectual Property Rights safeguards should become the norm to provide quality-assured and affordable drugs within competitive generic markets. CONCLUSION: Does the political will exist among policymakers and other stakeholders to develop and implement these country, regional and global frameworks for non-HIV drugs as they did for antiretroviral drugs?


Assuntos
Antirretrovirais/economia , Antirretrovirais/uso terapêutico , Países em Desenvolvimento , Custos de Medicamentos/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Política , Antirretrovirais/provisão & distribução , Comércio , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Humanos , Renda , Patentes como Assunto , Saúde Pública , Qualidade da Assistência à Saúde
15.
PLoS One ; 14(3): e0212405, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30861000

RESUMO

BACKGROUND: HIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world's largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic. METHODS: We conducted a cross-sectional telephonic survey (October-December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact. RESULTS: Nationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month. INTERPRETATION: There was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.


Assuntos
Antirretrovirais/provisão & distribução , Antituberculosos/provisão & distribução , Administração em Saúde Pública/métodos , Antirretrovirais/uso terapêutico , Antituberculosos/uso terapêutico , Serviços de Saúde Comunitária/métodos , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Instalações de Saúde , Humanos , Masculino , Saúde Pública , Setor Público , África do Sul , Inquéritos e Questionários , Tuberculose/tratamento farmacológico
16.
J Assoc Nurses AIDS Care ; 30(5): 511-520, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30720561

RESUMO

Scale-up of antiretroviral therapy (ART) for people living with HIV requires differentiated models of ART delivery to improve access and contribute to achieving viral suppression for 95% of people on ART. We examined barriers and enablers in South Africa via semistructured interviews with 33 respondents (program implementers, nurses, and other health care providers) from 11 organizations. The interviews were recorded, transcribed, and analyzed for emerging themes using NVivo 11 software. Major enablers of ART delivery included model flexibility, provision of standardized guidance, and an increased focus on person-centered care. Major barriers were related to financial, human, and space resources and the need for time to allow buy-in. Stigma emerged as both a barrier and an enabler. Findings suggest that creating and strengthening models that cater to client needs can achieve better health outcomes. South Africa's efforts can inform emerging models in other settings to achieve epidemic control.


Assuntos
Fármacos Anti-HIV/provisão & distribução , Antirretrovirais/provisão & distribução , Terapia Antirretroviral de Alta Atividade/métodos , Serviços de Saúde Comunitária/organização & administração , Infecções por HIV/tratamento farmacológico , Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Adesão à Medicação/psicologia , Assistência Centrada no Paciente , Estigma Social , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Atitude do Pessoal de Saúde , Pesquisa Participativa Baseada na Comunidade , Feminino , Grupos Focais , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Adesão à Medicação/estatística & dados numéricos , Equipe de Assistência ao Paciente , Pesquisa Qualitativa , África do Sul
18.
AIDS Behav ; 23(8): 2079-2087, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30535835

RESUMO

We studied the motivations behind supply and demand of antiretroviral drugs (ARVs) in the illicit street markets of the metropolitan statistical area of Atlanta, Sandy Springs, and Roswell, Georgia. We found that these two market actions were largely interdependent: 39.53% of participants said that they sold their ARVs to pay for personal needs, and 20.93% said that they bought ARVs because they had previously sold them to pay for personal needs. The pattern that emerged suggests that illicit street markets have become mechanisms through which HIV patients cooperate to achieve competing goals: cover personal needs and keep up, however imperfectly, with their medication regime. We also found that HIV patients used illicit street markets because they faced institutional deficiencies, such as exclusion from the Ryan White/ADAP program, long waiting times to see a doctor, and prescription delays.


Assuntos
Antirretrovirais/provisão & distribução , Comércio/economia , Medicamentos Falsificados , Prescrições de Medicamentos , Infecções por HIV/tratamento farmacológico , Motivação , Adolescente , Adulto , Antirretrovirais/economia , Antirretrovirais/uso terapêutico , Feminino , Georgia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
19.
Trop Med Int Health ; 24(2): 238-246, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30422371

RESUMO

OBJECTIVE: To assess the proportion and sales of unapproved Fixed Dose Combinations (FDCs) of anti-tubercular, antimalarial and antiretroviral medicines available on the Indian market. METHODS: Available FDCs of anti-tubercular, antimalarial and antiretrovirals were screened against the Central Drugs Standard Control Organization (CDSCO) database of approved FDCs. The FDC sales information in the given categories was obtained from AIOCD AWACS PharmaTrac, a market database. FDCs available in India were also screened against the National List of Essential Medicines India 2015 and the Orange Book Database of products approved by USFDA. RESULTS: Of 110 available first- to fourth-line anti-tubercular FDCs, only 32 were approved. Of 20 antimalarial FDCs available, eight were approved. However, almost 95% of available antiretroviral FDCs and branded products were approved. The sales volume of all anti-tubercular drugs was 730 million units of which 71% were unapproved, amounting to 14.30 billion rupees in sales value (58%). Almost half of the sales value and volume of antimalarials was generated by unapproved products. About 1% of sales volume of antiretroviral FDCs came from unapproved formulations, accounting for 5% of sales value. CONCLUSION: A large proportion of FDC formulations available in India has never been approved by CDSCO, hence raising the doubts about their safety and efficacy. An opaque regulatory framework and ambiguity over licensing powers have contributed to the problem. The rationality of unapproved FDCs should be reviewed and irrational formulations should be banned.


Assuntos
Antirretrovirais/provisão & distribução , Antimaláricos/provisão & distribução , Antituberculosos/provisão & distribução , Combinação de Medicamentos , Humanos , Índia , Legislação de Medicamentos
20.
Glob Health Sci Pract ; 6(4): 723-735, 2018 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-30591578

RESUMO

The success of the Namibian government's "treatment for all" approach to control and stop the country's HIV epidemic is dependent on an uninterrupted supply of antiretrovirals (ARVs) for people living with HIV. The public health system in Namibia, however, was constrained by an inefficient paper-based pharmaceutical information system resulting in unreliable and inaccessible data, contributing to persistent stock-outs of ARVs and other essential pharmaceuticals. This article describes the incremental implementation of an integrated pharmaceutical management information system to provide timely and reliable commodity and patient data for decision making in Namibia's national antiretroviral therapy (ART) program and the Ministry of Health and Social Services (MoHSS). The system has 4 interlinked information tools: (1) the Electronic Dispensing Tool (EDT) that manages the dispensing and inventory of antiretrovirals at service delivery points; (2) the EDT national database, which facilitates the flow, storage, and collation of ART data at the central level; (3) the Facility Electronic Stock Card used to manage pharmaceutical stocks and report inventory movement data to the national level; and (4) the Pharmaceutical Management Information Dashboard that integrates all 3 tools plus the warehouse management tool used by the central and regional medical stores into 1 dashboard that serves as a platform for the analysis and dissemination of pharmaceutical information throughout the health system. Implementing the pharmaceutical management information system was a prolonged and complicated process, with key challenges related to user acceptance and human resource constraints. The integrated pharmaceutical management information system enables Namibia to collect more than 90% of transactional commodity and patient dispensing data from more than 85% of all ART sites. Health managers use information from the system for medicine quantification decisions and to improve pharmaceutical service delivery. The MoHSS and its partners in the national ART program use the information for monitoring the World Health Organization early warning indicators for HIV drug resistance; ART defaulter tracing; and for planning, reporting, and research purposes. Namibia's pharmaceutical management information system demonstrates the feasibility and benefits of integrating related tools while maintaining their specialized functionality to address country-specific information and inventory management needs.


Assuntos
Antirretrovirais/provisão & distribução , Prestação Integrada de Cuidados de Saúde , Infecções por HIV/tratamento farmacológico , Acesso aos Serviços de Saúde , Sistemas de Informação Administrativa , Bases de Dados Factuais , Humanos , Namíbia , Estudos de Casos Organizacionais , Desenvolvimento de Programas
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