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Ferdiana A, Mashuri YA, Wulandari LPL, Rahayu ID, Hasanah M, Ayuningsih Z, Batura N, Khan M, Liverani M, Guy R, Schierhout G, Kaldor J, Law M, Day R, Jan S, Wibawa T, Probandari A, Yeung S, Wiseman V. The impact of a multi-faceted intervention on non-prescription dispensing of antibiotics by urban community pharmacies in Indonesia: a mixed methods evaluation. BMJ Glob Health 2024; 9:e015620. [PMID: 39366709 DOI: 10.1136/bmjgh-2024-015620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/22/2024] [Indexed: 10/06/2024] Open
Abstract
INTRODUCTION Non-prescription antibiotic dispensing is prevalent among community pharmacies in several low- and middle-income countries. We evaluated the impact of a multi-faceted intervention to address this challenge in urban community pharmacies in Indonesia. METHODS A pre-post quasi-experimental study was carried out in Semarang city from January to August 2022 to evaluate a 7-month long intervention comprising: (1) online educational sessions for pharmacists; (2) awareness campaign targeting customers; (3) peer visits; and (4) pharmacy branding and pharmacist certification. All community pharmacies were invited to take part with consenting pharmacies assigned to the participating group and all remaining pharmacies to the non-participating group. The primary outcome (rate of non-prescription antibiotic dispensing) was measured by standardised patients displaying symptoms of upper respiratory tract infection, urinary tract infection (UTI) and seeking care for diarrhoea in a child. χ2 tests and multivariate random-effects logistic regression models were conducted. Thirty in-depth interviews were conducted with pharmacists, staff and owners as well as other relevant stakeholders to understand any persistent barriers to prescription-based dispensing of antibiotics. FINDINGS Eighty pharmacies participated in the study. Postintervention, non-prescription antibiotics were dispensed in 133/240 (55.4%) consultations in the participating group compared with 469/570 (82.3%) in the non-participating group (p value <0.001). The pre-post difference in the non-prescription antibiotic dispensing rate in the participating group was 20.9% (76.3%-55.4%) compared with 2.3% (84.6%-82.3%) in the non-participating group (p value <0.001).Non-prescription antibiotics were less likely to be dispensed in the participating group (OR=0.19 (95% CI 0.09 to 0.43)) and more likely to be dispensed for the UTI scenario (OR=3.29 (95% CI 1.56 to 6.94)). Barriers to prescription-based antibiotic dispensing included fear of losing customers, customer demand, and no supervising pharmacist present. INTERPRETATION Multifaceted interventions targeting community pharmacies can substantially reduce non-prescription antibiotic dispensing. Future studies to evaluate the implementation and sustainability of this intervention on a larger scale are needed.
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Affiliation(s)
- Astri Ferdiana
- Faculty of Medicine and Health Sciences, University of Mataram, Mataram, Indonesia
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yusuf Ari Mashuri
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | | | | | - Miratul Hasanah
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Zulfa Ayuningsih
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Neha Batura
- Institute of Global Health, University College London, London, UK
| | - Mishal Khan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- The Aga Khan University, Karachi, Pakistan
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Faculty of Public Health, Mahidol University, Salaya, Thailand
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Gill Schierhout
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Day
- St Vincent's Clinical Campus, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Jan
- Health Economics and Process Evaluation Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Tri Wibawa
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Microbiology, Facuty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ari Probandari
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Public Health, Faculty of Medicine Universitas Sebelas Maret, Surakarta, Indonesia
| | - Shunmay Yeung
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Llor C, Benkő R, Bjerrum L. Global restriction of the over-the-counter sale of antimicrobials: does it make sense? Front Public Health 2024; 12:1412644. [PMID: 39022420 PMCID: PMC11251895 DOI: 10.3389/fpubh.2024.1412644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Affiliation(s)
- Carl Llor
- University Institute in Primary Care Research Jordi Gol, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Madrid, Spain
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ria Benkő
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Lars Bjerrum
- Section and Research Unit of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Nabeel M, Ali K, Sarwar MR, Waheed I. Assessment of knowledge, attitudes, and practices among community pharmacists in Lahore regarding antibiotic dispensing without prescription: A cross-sectional study. PLoS One 2024; 19:e0304361. [PMID: 38870190 PMCID: PMC11175427 DOI: 10.1371/journal.pone.0304361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/11/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVES The irrational dispensing practices are responsible for antibiotic abuse and the spread of antibiotic resistance. Thus, the present study aims to evaluate the knowledge, attitudes, and practices of community pharmacists (CPs) regarding dispensing antibiotics without prescription (DAwP). METHOD A descriptive, cross-sectional study was conducted between March 1, 2023, and March 31, 2023, in community pharmacy settings of Lahore, Pakistan. A self-administered and pretested questionnaire was used for the data collection. Logistic regression analysis was used to determine the factors associated with the practices of community pharmacists. Data were analyzed using SPSS (version 26) and MS Office (2016). RESULTS Among 359 respondents, many strongly agreed/agreed with the statements "DAwP is contributing to the development of antimicrobial resistance" (83%, n = 298) and "Antibiotic resistance has become a public health issue" (81.9%, n = 249). Overall, most of the community pharmacists claimed that the unwillingness of patients to visit physicians for non-serious infections (75.2%, n = 270) and good knowledge of pharmacists about the use of antibiotics (51%, n = 183) were the most common reasons attributable to dispensing of antibiotics without prescription. Cephalosporin (n = 260, 72.4%), penicillin (n = 254, 70.8%), and tetracyclines (n = 170, 47.4%) were the most commonly dispensed classes of antibiotics without prescription due to cold, flu and diarrhea. Most community pharmacists never/sometimes warn patients about the potential side effects of medicines (79.1%, n = 284). Logistic regression analysis revealed that community pharmacists 31-40 years of age (OR = 0.568, 95%CI = 0.348-0.927, p-value = 0.024) were significantly less associated with poor practices of dispensing antibiotics without prescription (DAwP) while those who were 'Managers' (OR = 4.222, 95%CI = 2.542-7.011, p-value = <0.001), had 3-5 years of experience (OR = 2.241, 95%CI = 1.183-4.243, p-value = 0.013), dispensed ≤25 antibiotics per day (OR = 12.375, 95%CI = 5.177-29.583, p-value = <0.001), were more likely to be associated with poor practices of dispensing of antibiotics without prescription. CONCLUSION The community pharmacists had adequate knowledge, positive attitudes, and poor practices towards DAwP. Demographical factors such as age, job status, and work experience were the determinants of community pharmacists' practices towards dispensing antibiotics without prescription (DAwP). Hence, a multifaceted approach, including educational interventions, is needed to reduce the dispensing of antibiotics without prescription (DAwP).
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Affiliation(s)
- Muhammad Nabeel
- Department of Oncology Pharmacy, Cancer Care Hospital & Research Centre, Lahore, Punjab, Pakistan
- Department of Clinical Pharmacy, Akhtar Saeed College of Pharmaceutical Sciences (ACPS), Lahore, Punjab, Pakistan
| | - Khubaib Ali
- Department of Oncology Pharmacy, Cancer Care Hospital & Research Centre, Lahore, Punjab, Pakistan
- Department of Clinical Pharmacy, Akhtar Saeed College of Pharmaceutical Sciences (ACPS), Lahore, Punjab, Pakistan
| | - Muhammad Rehan Sarwar
- Department of Clinical Pharmacy, Akhtar Saeed College of Pharmaceutical Sciences (ACPS), Lahore, Punjab, Pakistan
| | - Imran Waheed
- Department of Pharmacognosy, Akhtar Saeed College of Pharmacy, Canal Campus (ASCP), Lahore, Punjab, Pakistan
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Cernasev A, Stillo J, Black J, Batchu M, Bell E, Tschampl CA. Pharmacists' Role in Global TB Elimination: Practices, Pitfalls, and Potential. Healthcare (Basel) 2024; 12:1137. [PMID: 38891212 PMCID: PMC11171989 DOI: 10.3390/healthcare12111137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/15/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Tuberculosis (TB) is the top infectious killer in the world despite efforts to eliminate it. Pharmaceutical care roles are pillars of pharmacy practice, and pharmacists are well equipped to serve a unique role in the pathway to provide education about TB. Previous systematic reviews emphasize pharmacists' role in treating TB; however, pharmacists can and do play much broader roles in overall TB elimination efforts. Five researchers searched five electronic databases (PubMed, PsychInfo, CINAHL, Academic Search Premier, and Embase). Search terms included pharmacy, pharmacist, tuberculosis, antitubercular agents, supply, distribution, and drug therapy. Inclusion criteria were studies published from 2010 through March 2023, in English or Spanish, addressed a specific TB-related role for pharmacists/pharmacies, and were peer-reviewed. Exclusion criteria included pharmacology, pharmacokinetics, clinical trials on drug efficacy, and editorials. Two researchers conducted each level of review; for discordance, a third researcher reviewed, and a decision was reached by consensus. Roles were extracted and cross-referenced with traditional pharmaceutical care steps. Of the initial 682 hits, 133 were duplicates. After further review, we excluded 514 records, leaving 37 articles for full extraction. We found nine roles for pharmacists in TB prevention and classified them as implemented, not implemented, or recommended. These roles were: (1) TB symptom screening; (2) Referring to TB care systems; (3) TB testing; (4) Dispensing TB medication correctly and/or directly observed therapy; (5) Counseling; (6) Looking to reduce socioeconomic barriers; (7) Procurement of TB medications; (8) Quality assurance of TB medications; (9) Maintaining and using pharmacy data systems. Pharmacists are well situated to play a vital role in the global fight against TB. Findings suggested pharmacists in many settings have already expanded their roles related to TB elimination beyond traditional pharmaceutical care. Still others need to increase the understanding of TB procurement and treatment, their power to improve TB care, and their contributions to data systems that serve population health. Pharmacy curricula should increase TB-related training to better equip future pharmacists to contribute to TB elimination.
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Affiliation(s)
- Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA;
| | - Jonathan Stillo
- Department of Anthropology, Wayne State University, 656 W. Kirby St. 3054 FA/B, Detroit, MI 48202, USA; (J.S.); (E.B.)
| | - Jolie Black
- Schneider Institutes for Health Policy and Research, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA;
| | - Mythili Batchu
- Department of Public Health, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL 33313, USA;
| | - Elaina Bell
- Department of Anthropology, Wayne State University, 656 W. Kirby St. 3054 FA/B, Detroit, MI 48202, USA; (J.S.); (E.B.)
| | - Cynthia A. Tschampl
- Schneider Institutes for Health Policy and Research, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA;
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Jhaveri TA, Jhaveri D, Galivanche A, Lubeck-Schricker M, Voehler D, Chung M, Thekkur P, Chadha V, Nathavitharana R, Kumar AMV, Shewade HD, Powers K, Mayer KH, Haberer JE, Bain P, Pai M, Satyanarayana S, Subbaraman R. Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies. PLoS Med 2024; 21:e1004409. [PMID: 38805509 PMCID: PMC11166313 DOI: 10.1371/journal.pmed.1004409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/11/2024] [Accepted: 04/29/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND India accounts for about one-quarter of people contracting tuberculosis (TB) disease annually and nearly one-third of TB deaths globally. Many Indians do not navigate all care cascade stages to receive TB treatment and achieve recurrence-free survival. Guided by a population/exposure/comparison/outcomes (PECO) framework, we report findings of a systematic review to identify factors contributing to unfavorable outcomes across each care cascade gap for TB disease in India. METHODS AND FINDINGS We defined care cascade gaps as comprising people with confirmed or presumptive TB who did not: start the TB diagnostic workup (Gap 1), complete the workup (Gap 2), start treatment (Gap 3), achieve treatment success (Gap 4), or achieve TB recurrence-free survival (Gap 5). Three systematic searches of PubMed, Embase, and Web of Science from January 1, 2000 to August 14, 2023 were conducted. We identified articles evaluating factors associated with unfavorable outcomes for each gap (reported as adjusted odds, relative risk, or hazard ratios) and, among people experiencing unfavorable outcomes, reasons for these outcomes (reported as proportions), with specific quality or risk of bias criteria for each gap. Findings were organized into person-, family-, and society-, or health system-related factors, using a social-ecological framework. Factors associated with unfavorable outcomes across multiple cascade stages included: male sex, older age, poverty-related factors, lower symptom severity or duration, undernutrition, alcohol use, smoking, and distrust of (or dissatisfaction with) health services. People previously treated for TB were more likely to seek care and engage in the diagnostic workup (Gaps 1 and 2) but more likely to suffer pretreatment loss to follow-up (Gap 3) and unfavorable treatment outcomes (Gap 4), especially those who were lost to follow-up during their prior treatment. For individual care cascade gaps, multiple studies highlighted lack of TB knowledge and structural barriers (e.g., transportation challenges) as contributing to lack of care-seeking for TB symptoms (Gap 1, 14 studies); lack of access to diagnostics (e.g., X-ray), non-identification of eligible people for testing, and failure of providers to communicate concern for TB as contributing to non-completion of the diagnostic workup (Gap 2, 17 studies); stigma, poor recording of patient contact information by providers, and early death from diagnostic delays as contributing to pretreatment loss to follow-up (Gap 3, 15 studies); and lack of TB knowledge, stigma, depression, and medication adverse effects as contributing to unfavorable treatment outcomes (Gap 4, 86 studies). Medication nonadherence contributed to unfavorable treatment outcomes (Gap 4) and TB recurrence (Gap 5, 14 studies). Limitations include lack of meta-analyses due to the heterogeneity of findings and limited generalizability to some Indian regions, given the country's diverse population. CONCLUSIONS This systematic review illuminates common patterns of risk that shape outcomes for Indians with TB, while highlighting knowledge gaps-particularly regarding TB care for children or in the private sector-to guide future research. Findings may inform targeting of support services to people with TB who have higher risk of poor outcomes and inform multicomponent interventions to close gaps in the care cascade.
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Affiliation(s)
- Tulip A. Jhaveri
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Disha Jhaveri
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Amith Galivanche
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Maya Lubeck-Schricker
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Dominic Voehler
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Mei Chung
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- South-East Asia Office, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | | | - Ruvandhi Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ajay M. V. Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- South-East Asia Office, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (deemed to be university), Mangalore, India
| | - Hemant Deepak Shewade
- Division of Health Systems Research, ICMR-National Institute of Epidemiology, Chennai, India
| | - Katherine Powers
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Kenneth H. Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Boston, Massachusetts, United States of America
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Paul Bain
- Countway Library of Medicine, Boston, Massachusetts, United States of America
| | - Madhukar Pai
- Department of Global and Public Health and McGill International TB Centre, McGill University, Montreal, Canada
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- South-East Asia Office, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Ramnath Subbaraman
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, Massachusetts, United States of America
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Gillani AH, Arshad H, Mujtaba H, Umer MF, Xu S, Ji W, Bashir K, Chang J, Yang C, Fang Y. Dispensing of antibiotics for tuberculosis patients using standardized patient approach at community pharmacies: results from a cross-sectional study in Pakistan. Front Public Health 2024; 11:1241551. [PMID: 38259789 PMCID: PMC10801376 DOI: 10.3389/fpubh.2023.1241551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Background Pakistan is among top countries for antibiotic consumption around the globe and patients often receive antibiotics directly from community pharmacies. Thus, our aim was to assess the drug dispensing practices of pharmacies for presumed and confirmed tuberculosis by using standardized patients' method in Pakistan. Methods In this cross-sectional study, we adopted two standardized patient cases in pharmacies of three cities of Punjab. The first case involved a presumed tuberculosis patient presenting with 2-3 weeks of cough and fever (Case-1), and the second case involved a confirmed tuberculosis patient carrying microbiologically confirmed tuberculosis results (Case-2). The ideal management for Cases-1 and Case-2 is referral of standardized patients to a healthcare provider without dispensing antibiotics or steroids, or both. The differences in antibiotic use, steroid use, and the number of medicines dispensed in referred and non-referred patients between Case-1 and Case-2 were analyzed using descriptive statistics. Results Between April 1, 2020, and July 31, 2020, standardized patients completed 575 out of 598 interactions among community pharmacies in Lahore, Rawalpindi, and Sialkot. We recorded ideal management in 115 (37.7%) of the 305 Case-1 interactions and 130 (48.1%) of the 270 Case-2 interactions. Antibiotic dispensing was higher in Case-1, with 71 out of 305 instances (23.3%), than in Case-2 interactions, with 27 out of 270 instances (10.0%). Anti-tuberculosis drugs were dispensed to 1 patient in Case-1 (0.3%) and to 19 patients (7.0%) in Case-2. Conclusion Slightly more than one-third of pharmacies in Punjab, Pakistan, ideally managed patients with presumed tuberculosis, but almost half of them ideally managed cases of confirmed tuberculosis. The presence of confirmed diagnosis slightly changes the behavior in the correct management of patients.
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Affiliation(s)
- Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, Shaanxi, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, Shaanxi, China
| | - Hafsa Arshad
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, Shaanxi, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, Shaanxi, China
| | - Hasan Mujtaba
- Department of Pathology, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | | | - Sen Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, Shaanxi, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, Shaanxi, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, Shaanxi, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, Shaanxi, China
| | - Kamran Bashir
- College of Pharmacy, University of Sargodha Pakistan, Sargodha, Pakistan
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, Shaanxi, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, Shaanxi, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, Shaanxi, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, Shaanxi, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, Shaanxi, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, Shaanxi, China
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Shah HD, Chaudhary S, Desai B, Patel J, Yasobant S, Bhavsar P, Saha S, Sinha AK, Saxena D, Patel Y, Modi B. Exploring private sector perspectives on barriers and facilitators in availing tuberculosis care cascade services: a qualitative study from the Indian state. BMC PRIMARY CARE 2024; 25:5. [PMID: 38166734 PMCID: PMC10759326 DOI: 10.1186/s12875-023-02244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION The private sector plays an important role in tuberculosis (TB) elimination by providing access to quality TB care services like diagnosis and treatment, advocacy for preventive measures, innovation to address challenges in TB elimination, vaccines etc. The study aims to understand the perspectives of private practitioners on patients' TB care cascade to reinforce existing interventions by assuring the quality of care to TB patients. METHODS The study utilized a qualitative design through in-depth interviews of private practitioners and was conducted in Ranchi and Purbi Singhbhum District of Jharkhand State from March-August 2021. The pilot-tested, semi-structured, open-ended interview guide questionnaire collected information from private practitioners on various aspects of the TB care cascade. The data from the provider interviews were transcribed into multiple codes and themes on the TB program. An inductive analysis was carried out with a focus on content credibility to eliminate bias. Ethical approval was received from the Institutional Ethics Committee of the Indian Institute of Public Health Gandhinagar (IIPHG), India. Written consent was taken from the private practitioners involved in the study. RESULT In-depth interviews of 17 private practitioners reveal various factors contributing to delays in TB care cascades, especially delay in access to TB diagnosis and TB Care, delay in providing treatment once after diagnosis and poor adherence to the TB treatment. According to the perception of private practitioners, there was an array of client, provider and system side factors affecting the TB care cascade gaps positively and negatively. Positive aspects mainly emerged from interviews: strong governance, consistent supply chain management, innovative PPP models and financial schemes reducing out-of-pocket expenditure (OOPE). Various factors affecting the TB care cascade negatively include awareness among the patient, socio-economic status, approach and decision-making power of providers, adverse effects of drugs, staff capacity building, etc. CONCLUSIONS: Engaging private practitioner in TB elimination efforts is critical to achieving global targets and reducing the burden of TB. The study helps to determine geography-specific barriers and facilitators of the TB care cascade to achieve the aim of providing universal access to TB healthcare with the inclusion of private practitioners.
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Affiliation(s)
- Harsh D Shah
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India.
| | - Shalu Chaudhary
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India
| | - Bharat Desai
- State Health System Resource Center, Government of Gujarat, Gujarat, India
| | - Jay Patel
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India
| | - Sandul Yasobant
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, India
| | - Priya Bhavsar
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India
| | - Somen Saha
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India
- State Health System Resource Center, Government of Gujarat, Gujarat, India
| | - Anish K Sinha
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India
| | - Deepak Saxena
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India
- State Health System Resource Center, Government of Gujarat, Gujarat, India
| | - Yogesh Patel
- John Snow India Pvt. Ltd. (JSIPL), New Delhi, India
| | - Bhavesh Modi
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India
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Sinha R, Rana RK, Kujur A, Jahnavi G, Kumar M, Venugopal V, Priya N, Kujur M, Jha RR, Barnwal R, Nishant N, Murmu N, Pathak R, T A, Prasad R, Dayal R, Modi B, Purty AJ, Bn S, Nair D, Kumar D. Trends of Private Drugs' Sales and Costs Incurred by Patients on Anti-tuberculosis Drugs in Selected Districts of Jharkhand (2022): Results From Sub-national TB-Free Certification. Cureus 2023; 15:e47296. [PMID: 38021489 PMCID: PMC10656432 DOI: 10.7759/cureus.47296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The government of India is committed to eliminating tuberculosis (TB) by 2025 under the National Tuberculosis Elimination Programme which provides free investigations and treatment as well as incentives for nutritional support during their treatment course. Many TB patients prefer to seek treatment from the private sector which sometimes leads to financial constraints for the patients. Our study aims to find the burden of TB patients in the private sector and the expenses borne by them for their treatment. METHODOLOGY Sales data of rifampicin-containing formulation drug consumption in the private sector of six districts of Jharkhand was collected from Clearing and Forwarding agencies. Based on the drug sales data, the total incurring costs of the drugs, total number of patients, and cost per patient seeking treatment from the private sector were calculated for the year 2015-2021. ANOVA and the post hoc test (Tukey honestly significant difference (HSD)) were applied for analysis. RESULTS There was a marked difference amongst all the districts in relation to all the variables namely total costs, cost per patient, and total private patients seeking treatment from the private sector which was statistically significant (p < 0.001). East Singhbhum had the highest out-of-pocket expense and private patients as compared to all six districts. Lohardaga showed the sharpest decline in total private patients from 2015 to 2021. The average cost borne by private patients in 2015 was INR 1821 (95% CI 1086 - 2556) which decreased to INR 1033 (95% CI 507 - 1559) in 2021. CONCLUSION From the study, it was concluded that the purchase of medicines for TB treatment from the private sector is one of the essential elements in out-of-pocket expenditure (OOPE) borne by TB patients. Hence, newer initiatives should be explored to foresee the future OOPE borne by the patients and decrease OOPE-induced poverty.
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Affiliation(s)
- Ratnesh Sinha
- Department of Community Medicine, Manipal Tata Medical College, Manipal Academy of Higher Education, Jamshedpur, IND
| | - Rishabh K Rana
- Department of Preventive and Social Medicine/Community Medicine, Shaheed Nirmal Mahto Medical College and Hospital (Erstwhile Patliputra Medical College), Dhanbad, IND
| | - Anit Kujur
- Department of Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - G Jahnavi
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Mithilesh Kumar
- Department of Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Vinayagamoorthy Venugopal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Neha Priya
- Department of Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Manisha Kujur
- Department of Preventive Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Ravi Ranjan Jha
- Department of Community Medicine, Shaheed Nirmal Mahto Medical College and Hospital (Erstwhile Patliputra Medical College), Dhanbad, IND
| | - Rajan Barnwal
- Department of Community Medicine, Mahatma Gandhi Memorial Medical College and Hospital, Jamshedpur, IND
| | - Nikhil Nishant
- Department of Community Medicine, Medinirai Medical College, Palamu, IND
| | - Nisha Murmu
- Department of Preventive Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Rajeev Pathak
- NTEP Technical Support Network, World Health Organization, Ranchi, IND
| | - Anupama T
- NTEP Technical Support Network, World Health Organization, Ranchi, IND
| | - Ranjit Prasad
- State TB Cell, Health Services, Government of Jharkhand, Ranchi, IND
| | - Rakesh Dayal
- State TB Cell, Health Services, Government of Jharkhand, Ranchi, IND
| | - Bhavesh Modi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rajkot, Rajkot, IND
| | - Anil J Purty
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Sharath Bn
- Department of Community Medicine, Employees' State Insurance Corporation (ESIC) Medical College and Post Graduate Institute of Medical Science & Research (PGIMSR), Bengaluru, IND
| | - Dina Nair
- Department of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis (ICMR-NIRT), Chennai, IND
| | - Dewesh Kumar
- Department of Community Medicine/Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
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9
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Kalita A, Bose B, Woskie L, Haakenstad A, Cooper JE, Yip W. Private pharmacies as healthcare providers in Odisha, India: analysis and implications for universal health coverage. BMJ Glob Health 2023; 8:e008903. [PMID: 37778756 PMCID: PMC10546140 DOI: 10.1136/bmjgh-2022-008903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/15/2022] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION In India, as in many low-income and middle-income countries, the private sector provides a large share of health care. Pharmacies represent a major share of private care, yet there are few studies on their role as healthcare providers. Our study examines: (1) What are the characteristics of and services provided by private pharmacies and how do these compare with other outpatient care providers? (2) What are the characteristics of patients who opted to use private pharmacies? (3) What are the reasons why people seek healthcare from private pharmacies? (4) What are the quality of services and cost of care for these patients? Based on our findings, we discuss some policy implications for universal health coverage in the Indian context. METHODS We analyse data from four surveys in Odisha, one of India's poorest states: a household survey on health-seeking behaviours and reasons for healthcare choices (N=7567), a survey of private pharmacies (N=1021), a survey of public sector primary care facilities (N=358), and a survey of private-sector solo-providers (N=684). RESULTS 17% of the households seek outpatient care from private pharmacies (similar to rates for public primary-care facilities). 25% of the pharmacies were not registered appropriately under Indian regulations, 90% reported providing medical advice, and 26% reported substituting prescribed drugs. Private pharmacies had longer staffed hours and better stocks of essential drugs than public primary-care facilities. Patients reported choosing private pharmacies because of convenience and better drug stocks; reported higher satisfaction and lower out-of-pocket expenditure with private pharmacies than with other providers. CONCLUSION This is the first large-scale study of private pharmacies in India, with a comparison to other healthcare providers and users' perceptions and experiences of their services. To move towards universal health coverage, India, a country with a pluralistic health system, needs a comprehensive health systems approach that incorporates both the public and private sectors, including private pharmacies.
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Affiliation(s)
- Anuska Kalita
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bijetri Bose
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Liana Woskie
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Tufts University School of Arts and Sciences, Medford, MA, USA
| | - Annie Haakenstad
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jan E Cooper
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Winnie Yip
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Miller R, Wafula F, Eman KU, Rakesh PS, Faleye BO, Duggan C, Sousa Pinto G, Heitkamp P, Rana N, Klinton JS, Sulis G, Oga-Omenka C, Pai M. Pharmacy engagement in TB prevention and care: not if, but how? BMJ Glob Health 2023; 8:e013104. [PMID: 37474278 PMCID: PMC10360412 DOI: 10.1136/bmjgh-2023-013104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Rosalind Miller
- TBPPM Learning Network, Research Institute McGill University Health Center (RI-MUHC), Montreal, Quebec, Canada
| | - Francis Wafula
- Institute of Healthcare Management, Strathmore University Strathmore Business School, Nairobi, Kenya
| | | | - P S Rakesh
- Amity Institute of Public Health & Hospital Administration, Amity University, Noida, Uttar Pradesh, India
| | - Bolanle Olusola Faleye
- USAID Local Health Systems Sustainability project (LHSS), Abt Associates Nigeria, Lagos, Nigeria
| | - Catherine Duggan
- International Pharmaceutical Federation (FIP), The Hague, The Netherlands
| | | | - Petra Heitkamp
- TBPPM Learning Network, Research Institute McGill University Health Center (RI-MUHC), Montreal, Quebec, Canada
| | - Namrata Rana
- TBPPM Learning Network, Research Institute McGill University Health Center (RI-MUHC), Montreal, Quebec, Canada
| | - Joel Shyam Klinton
- TBPPM Learning Network, Research Institute McGill University Health Center (RI-MUHC), Montreal, Quebec, Canada
| | - Giorgia Sulis
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Charity Oga-Omenka
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Madhukar Pai
- McGill School of Population and Global Health, McGill University, Montreal, Quebec, Canada
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11
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Kausar MN, Fitriana E, Khairunnisa K, Faruque MO, Bahar MA, Alfian SD, Pradipta IS. Development and Validation of the Knowledge, Attitude, and Practice Questionnaire for Community Pharmacy Personnel in Tuberculosis Case Detection, Drug Monitoring, and Education: A Study from Indonesia. Infect Drug Resist 2023; 16:3729-3741. [PMID: 37333684 PMCID: PMC10276589 DOI: 10.2147/idr.s409107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background Validated and standardized structured questionnaires based on psychometric analysis are extremely limited, particularly for assessing community pharmacy personnel's knowledge, attitude, and practice (KAP) in tuberculosis (TB) case detection, drug monitoring, and education. We, therefore, developed and validated a questionnaire to assess the KAP of community pharmacy personnel in TB case detection, drug monitoring, and community education. Methods This study was conducted in two phases. First, we developed the questionnaire, which included framework development, item generation, individual item content validity index (I-CVI), item screening, and pre-testing. Second, we validated the questionnaire with 400 participants using various analyses, including participant analysis, confirmatory factor analysis (CFA), adjusted goodness-of-fit index (AGFI), comparative fit index (CFI), non-normed fit index (NNFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). We determined the reliability test using Cronbach's alpha and test-retest reliability using Pearson's correlation. Results In the development phase, we defined 63 items that comprised 18 sociodemographic, 18 knowledge, 18 attitude, and 9 practice items. Across the 63 items, the I-CVI scores of sociodemographic and KAP items were one each. The CFA model parameter values were X2/df= 2.28; AGFI = 0.95; CFI = 0.99; NNFI = 0.98; RMSEA = 0.06; and SRMR = 0.03 (p < 0.05 for all). Cronbach's alpha coefficients of KAP items were 0.75, 0.91, and 0.95, respectively. The test-retest reliability coefficients of KAP were 0.84, 0.55, and 0.91, respectively (p < 0.01). Conclusion This study indicates that the developed questionnaire is a valid and reliable instrument for assessing the KAP of community pharmacy personnel for TB case detection, drug monitoring, and community education in Indonesia. Community pharmacy personnel can support TB notification and treatment by assessing their prospective roles in surveys using this questionnaire, enabling TB eradication in 2030.
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Affiliation(s)
- Mersa Nurain Kausar
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Master of Clinical Pharmacy Program, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- Occupational Health – Regional Public Hospital, West Java Provincial Government, Bandung, Indonesia
| | - Efi Fitriana
- Department of General Psychology and Experiment, Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Md Omar Faruque
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Muh Akbar Bahar
- Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
| | - Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Ivan Surya Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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12
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Svadzian A, Daniels B, Sulis G, Das J, Daftary A, Kwan A, Das V, Das R, Pai M. Do private providers initiate anti-tuberculosis therapy on the basis of chest radiographs? A standardised patient study in urban India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 13:100152. [PMID: 37383564 PMCID: PMC10306035 DOI: 10.1016/j.lansea.2023.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 06/30/2023]
Abstract
Background The initiation of anti-tuberculosis treatment (ATT) based on results of WHO-approved microbiological diagnostics is an important marker of quality tuberculosis (TB) care. Evidence suggests that other diagnostic processes leading to treatment initiation may be preferred in high TB incidence settings. This study examines whether private providers start anti-TB therapy on the basis of chest radiography (CXR) and clinical examinations. Methods This study uses the standardized patient (SP) methodology to generate accurate and unbiased estimates of private sector, primary care provider practice when a patient presents a standardized TB case scenario with an abnormal CXR. Using multivariate log-binomial and linear regressions with standard errors clustered at the provider level, we analyzed 795 SP visits conducted over three data collection waves from 2014 to 2020 in two Indian cities. Data were inverse-probability-weighted based on the study sampling strategy, resulting in city-wave-representative results. Findings Amongst SPs who presented to a provider with an abnormal CXR, 25% (95% CI: 21-28%) visits resulted in ideal management, defined as the provider prescribing a microbiological test and not offering a concurrent prescription for a corticosteroid or antibiotic (including anti-TB medications). In contrast, 23% (95% CI: 19-26%) of 795 visits were prescribed anti-TB medications. Of 795 visits, 13% (95% CI: 10-16%) resulted in anti-TB treatment prescriptions/dispensation and an order for confirmatory microbiological testing. Interpretation One in five SPs presenting with abnormal CXR were prescribed ATT by private providers. This study contributes novel insights to empiric treatment prevalence based on CXR abnormality. Further work is needed to understand how providers make trade-offs between existing diagnostic practices, new technologies, profits, clinical outcomes, and the market dynamics with laboratories. Funding This study was funded by the Bill & Melinda Gates Foundation (grant OPP1091843), and the Knowledge for Change Program at The World Bank.
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Affiliation(s)
- Anita Svadzian
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Giorgia Sulis
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
- Centre for Policy Research, New Delhi, India
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, School of Global Health, York University, Toronto, ON, Canada
- Centre for the Aids Programme of Research in South Africa MRC-HIV-TB Pathogenesis and Treatment, Research Unit, Durban, South Africa
| | - Ada Kwan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, USA
| | - Ranendra Das
- Institute for Socio-Economic Research on Development and Democracy, Delhi, India
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- McGill International TB Centre, McGill University, Montreal, QC, Canada
- Manipal McGill Program for Infectious Diseases, Manipal Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India
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13
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Svadzian A, Daniels B, Sulis G, Das J, Daftary A, Kwan A, Das V, Das R, Pai M. Use of standardised patients to assess tuberculosis case management by private pharmacies in Patna, India: A repeat cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001898. [PMID: 37235550 PMCID: PMC10218738 DOI: 10.1371/journal.pgph.0001898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023]
Abstract
As the first point of care for many healthcare seekers, private pharmacies play an important role in tuberculosis (TB) care. However, previous studies in India have showed that private pharmacies commonly dispense symptomatic treatments and broad-spectrum antibiotics over-the-counter (OTC), rather than referring patients for TB testing. Such inappropriate management by pharmacies can delaye TB diagnosis. We assessed medical advice and OTC drug dispensing practices of pharmacists for standardized patients presenting with classic symptoms of pulmonary TB (case 1) and for those with sputum smear positive pulmonary TB (case 2), and examined how practices have changed over time in an urban Indian site. We examined how and whether private pharmacies improved practices for TB in 2019 compared to a baseline study conducted in 2015 in the city of Patna, using the same survey sampling techniques and study staff. The proportion of patient-pharmacist interactions that resulted in correct or ideal management, as well as the proportion of interactions resulting in antibiotic, quinolone, and corticosteroid are presented, with standard errors clustered at the provider level. To assess the difference in case management and the use of drugs across the two cases by round, a difference in difference (DiD) model was employed. A total of 936 SP interactions were completed over both rounds of survey. Our results indicate that across both rounds of data collection, 331 of 936 (35%; 95% CI: 32-38%) of interactions were correctly managed. At baseline, 215 of 500 (43%; 95% CI: 39-47%) of interactions were correctly managed whereas 116 of 436 (27%; 95% CI: 23-31%) were correctly managed in the second round of data collection. Ideal management, where in addition to a referral, patients were not prescribed any potentially harmful medications, was seen in 275 of 936 (29%; 95% CI: 27-32%) of interactions overall, with 194 of 500 (39%; 95% CI: 35-43%) of interactions at baseline and 81 of 436 (19%; 95% CI: 15-22%) in round 2. No private pharmacy dispensed anti-TB medications without a prescription. On average, the difference in correct case management between case 1 vs. case 2 dropped by 20 percent points from baseline to the second round of data collection. Similarly, ideal case management decreased by 26 percentage points between rounds. This is in contrast with the dispensation of medicines, which had the opposite effect between rounds; the difference in dispensation of quinolones between case 1 and case 2 increased by 14 percentage points, as did corticosteroids by 9 percentage points, antibiotics by 25 percentage points and medicines generally by 30 percentage points. Our standardised patient study provides valuable insights into how private pharmacies in an Indian city changed their management of patients with TB symptoms or with confirmed TB over a 5-year period. We saw that overall, private pharmacy performance has weakened over time. However, no OTC dispensation of anti-TB medications occurred in either survey round. As the first point of contact for many care seekers, continued and sustained efforts to engage with Indian private pharmacies should be prioritized.
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Affiliation(s)
- Anita Svadzian
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | | | - Giorgia Sulis
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jishnu Das
- Georgetown University, Washington, DC, United States of America
- Centre for Policy Research, New Delhi, India
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, School of Global Health, York University, Toronto, Ontario, Canada
- Centre for the Aids Programme of Research in South Africa MRC-HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Ada Kwan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ranendra Das
- Institute for Socio-Economic Research on Development and Democracy, Delhi, India
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
- Manipal McGill Program for Infectious Diseases, Manipal Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Miranda-Novales MG, Flores-Moreno K, Rodríguez-Álvarez M, López-Vidal Y, Soto-Hernández JL, Solórzano Santos F, Ponce-de-León-Rosales S. The Real Practice Prescribing Antibiotics in Outpatients: A Failed Control Case Assessed through the Simulated Patient Method. Antibiotics (Basel) 2023; 12:antibiotics12050915. [PMID: 37237818 DOI: 10.3390/antibiotics12050915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
The first level of medical care provides the largest number of consultations for the most frequent diseases at the community level, including acute pharyngitis (AP), acute diarrhoea (AD) and uncomplicated acute urinary tract infections (UAUTIs). The inappropriate use of antibiotics in these diseases represents a high risk for the generation of antimicrobial resistance (AMR) in bacteria causing community infections. To evaluate the patterns of medical prescription for these diseases in medical offices adjacent to pharmacies, we used an adult simulated patient (SP) method representing the three diseases, AP, AD and UAUTI. Each person played a role in one of the three diseases, with the signs and symptoms described in the national clinical practice guidelines (CPGs). Diagnostic accuracy and therapeutic management were assessed. Information from 280 consultations in the Mexico City area was obtained. For the 101 AP consultations, in 90 cases (89.1%), one or more antibiotics or antivirals were prescribed; for the 127 AD, in 104 cases (81.8%), one or more antiparasitic drugs or intestinal antiseptics were prescribed; for the scenarios involving UAUTIs in adult women, in 51 of 52 cases (98.1%) one antibiotic was prescribed. The antibiotic group with the highest prescription pattern for AP, AD and UAUTIs was aminopenicillins and benzylpenicillins [27/90 (30%)], co-trimoxazole [35/104 (27.6%)] and quinolones [38/51 (73.1%)], respectively. Our findings reveal the highly inappropriate use of antibiotics for AP and AD in a sector of the first level of health care, which could be a widespread phenomenon at the regional and national level and highlights the urgent need to update antibiotic prescriptions for UAUTIs according to local resistance patterns. Supervision of adherence to the CPGs is needed, as well as raising awareness about the rational use of antibiotics and the threat posed by AMR at the first level of care.
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Affiliation(s)
- María Guadalupe Miranda-Novales
- Unidad de Investigación en Análisis y Síntesis de la Evidencia, Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Mexico City 06720, Mexico
| | - Karen Flores-Moreno
- Laboratorio de Microbioma, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Mauricio Rodríguez-Álvarez
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Yolanda López-Vidal
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - José Luis Soto-Hernández
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico
| | - Fortino Solórzano Santos
- Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City 06720, Mexico
| | - Samuel Ponce-de-León-Rosales
- Programa Universitario de Investigación Sobre Riesgos Epidemiológicos y Emergentes, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
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15
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Daniels B, Shah D, Kwan AT, Das R, Das V, Puri V, Tipre P, Waghmare U, Gomare M, Keskar P, Das J, Pai M. Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India. BMJ Glob Health 2022; 7:e009657. [PMID: 36261230 PMCID: PMC9582305 DOI: 10.1136/bmjgh-2022-009657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors. METHODS We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai. RESULTS SPs presented a 'classic, suspected TB' scenario and a 'recurrence or drug-resistance' scenario. In the private sector, SPs completed 643 interactions. In the public sector, 164 interactions. Outcomes included indicators of correct management, medication use and client experience. Public providers used microbiological testing (typically, microscopy) more frequently, in 123 of 164 (75%; 95% CI 68% to 81%) vs 223 of 644 interactions (35%; 95% CI 31% to 38%) in the private sector. Private providers were more likely to order chest X-rays, in 556 of 639 interactions (86%; 95% CI 84% to 89%). According to national TB guidelines, we found higher proportions of correct management in the public sector (75% vs 35%; (adjusted) difference 35 percentage points (pp); 95% CI 25 to 46). If X-rays were considered acceptable for the first case but drug-susceptibility testing was required for the second case, the private sector correctly managed a slightly higher proportion of interactions (67% vs 51%; adjusted difference 16 pp; 95% CI 7 to 25). Broad-spectrum antibiotics were used in 76% (95% CI 66% to 84%) of the interactions in public hospitals, and 61% (95% CI 58% to 65%) in private facilities. Costs in the private clinics averaged rupees INR 512 (95% CI 485 to 539); public facilities charged INR 10. Private providers spent more time with patients (4.4 min vs 2.4 min; adjusted difference 2.0 min; 95% CI 1.2 to 2.9) and asked a greater share of relevant questions (29% vs 43%; adjusted difference 13.7 pp; 95% CI 8.2 to 19.3). CONCLUSIONS While the public providers did a better job of adhering to national TB guidelines (especially microbiological testing) and offered less expensive care, private sector providers did better on client experience.
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Affiliation(s)
- Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Daksha Shah
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Ada T Kwan
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ranendra Das
- Institute for Socio-Economic Research on Development and Democracy, Delhi, India
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Varsha Puri
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Pranita Tipre
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Upalimitra Waghmare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Mangala Gomare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Padmaja Keskar
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Québec, Canada
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16
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Community pharmacists-led interventions in tuberculosis care: A systematic review. Res Social Adm Pharm 2022; 19:5-15. [PMID: 36096865 DOI: 10.1016/j.sapharm.2022.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND A multidisciplinary approach is required to tackle the tuberculosis (TB) epidemic, which is one of the most pressing public health concerns worldwide. However, community pharmacists are underutilized in TB programs. OBJECTIVE To identify community pharmacists-led interventions in TB management with their corresponding impacts in TB case detection and treatment outcomes. METHODS A systematic search was performed in six electronic databases and health organization websites, from database inception to August 2, 2022. Studies which described TB screening, referral and/or treatment monitoring by community pharmacists with their corresponding outcomes were screened and reviewed independently by two reviewers. The studies were checked for the risk of bias using Cochrane risk of bias tools. All data of included studies were analysed qualitatively and presented narratively. RESULTS The search yielded 8,121 studies and five reports for initial screening. Sixteen studies and two case study reports were included in this review. Community pharmacists were involved throughout the TB care cascade, contributing their services in TB screening, referrals and in directly observed treatment-short course (DOTS) program. These interventions showed improvements in the effective control and prevention of further spread of TB, which improves individual, community and population level outcomes. CONCLUSIONS The inclusion of community pharmacists into TB program can improve the continuity of care, bridging the gaps in TB case detection and treatment monitoring. Adequate training and support are essential, to further empower the role of community pharmacists in TB control and prevention, in building a TB-free world.
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17
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Thapa P, Hall JJ, Jayasuriya R, Mukherjee PS, Beek K, Das DK, Mandal T, Narasimhan P. What are the Tuberculosis Care Practices of Informal Healthcare Providers? A Cross-Sectional Study from Eastern India. Health Policy Plan 2022; 37:1158-1166. [PMID: 35920775 DOI: 10.1093/heapol/czac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/23/2022] [Accepted: 08/02/2022] [Indexed: 11/14/2022] Open
Abstract
India is the highest Tuberculosis (TB) burden country, accounting for an estimated 26 % of the global burden of disease. Systematic engagement of the private sector is a cornerstone of India's National Strategic Plan (NSP) for TB elimination (2017-2025). However, Informal Healthcare Providers (IPs), who are the first point of contact for a large number of TB patients, remain significantly underutilised in the National TB Elimination Program (NTEP) of India. Non-prioritisation of IPs has also resulted in a limited understanding of their TB care practices in the community. We, therefore, undertook a descriptive study to document IPs' TB care practices, primarily focusing on their approach to screening, diagnosis, treatment, and referral. This cross-sectional study was carried out from February to March 2020 in the Birbhum District of West Bengal, India. Interviews were conducted utilising the retrospective case study method. A total 203 IPs participated who reported seeing at least one confirmed TB patient in six months prior to the study. In that duration, IPs reported interacting with an average of five suspected TB cases, two of which were later confirmed as having TB. Antibiotic use was found to be common among IPs (highest 69% during the first visit); however, they were prescribed before the patient was suspected or confirmed as having TB. We noted the practice of prolonged treatment among IPs as patients were prescribed medicines until the second follow-up visit. Referral was the preferred TB case management approach among IPs, but delayed referral was observed, with only one-third (34%) of patients being referred to higher health facilities during their first visit. This study presents important findings on IPs' TB care practices which have consequences for achieving India's National Goal of TB elimination.
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Affiliation(s)
- Poshan Thapa
- School of Population Health, University of New South Wales, Sydney, Australia.,Department of Public Health and Community Programs - Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - John J Hall
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Rohan Jayasuriya
- School of Population Health, University of New South Wales, Sydney, Australia
| | | | - Kristen Beek
- School of Population Health, University of New South Wales, Sydney, Australia
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18
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Pradipta IS, Khairunnisa K, Bahar MA, Kausar MN, Fitriana E, Ruslami R, Aarnoutse RE, Abdulah R. Knowledge, attitude and practice of community pharmacy personnel in tuberculosis patient detection: a multicentre cross-sectional study in a high-burden tuberculosis setting. BMJ Open 2022; 12:e060078. [PMID: 35790331 PMCID: PMC9258488 DOI: 10.1136/bmjopen-2021-060078] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Control of tuberculosis (TB) is hampered by suboptimal case detection and subsequent delays in treatment, which is worsened by the COVID-19 pandemic. The community pharmacy is reported as the place for first aid medication among patients with TB. We, therefore, analysed knowledge, attitude and practice (KAP) on TB patient detection (TBPD) of community pharmacy personnel, aiming to find innovative strategies to engage community pharmacies in TBPD. METHODS A multicentre cross-sectional study was performed in four areas of Indonesia's eastern, central and western parts. Pharmacists and pharmacy technicians who worked in community pharmacies were assessed for their characteristics and KAP related to TBPD. Descriptive analysis was used to assess participant characteristics and their KAP, while multivariable regression analyses were used to analyse factors associated with the KAP on TBPD. RESULTS A total of 1129 participants from 979 pharmacies, comprising pharmacists (56.6%) and pharmacy technicians (43.4%), were included. Most participants knew about TB. However, knowledge related to TB symptoms, populations at risk and medication for TB were still suboptimal. Most participants showed a positive attitude towards TBPD. They believed in their professional role (75.1%), capacity in TB screening (65.4%) and responsibility for TBPD (67.4%). Nevertheless, a lack of TBPD practice was identified in most participants. Several factors significantly associated with performing the TBPD practice (p<0.05), such as TB training experience (p<0.001), provision of a drug consultation service (p<0.001), male gender (p<0.05), a positive attitude towards TBPD (p<0.001), short working hours (p<0.001) and central city location of the pharmacy (p<0.05). CONCLUSIONS Most participants had good knowledge and attitude, which did not translate into actual TBPD practice. We identified that TB educational programmes are essential in improving the KAP. A comprehensive assessment is needed to develop effective strategies to engage the community pharmacy in TBPD activities.
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Affiliation(s)
- Ivan Surya Pradipta
- Departement of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | | | - Muh Akbar Bahar
- Departement of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
| | - Mersa Nurain Kausar
- Departement of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Master of Clinical Pharmacy Program, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Efi Fitriana
- Department of General and Experimental Psychology, Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- Department of Biomedical Sciences, Division of Pharmacology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rob E Aarnoutse
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rizky Abdulah
- Departement of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
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19
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Levofloxacin Use in Patients with Suspected Tuberculosis in a Community Hospital, Thailand: A Pilot Study. Adv Pharmacol Pharm Sci 2022; 2022:5647071. [PMID: 35692873 PMCID: PMC9187489 DOI: 10.1155/2022/5647071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/13/2022] [Accepted: 05/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background Levofloxacin is one of the broad-spectrum antibiotics that is indicated for the second-line treatment of tuberculosis (TB). However, using levofloxacin as an empirical therapy for patients without confirmation of TB could still be observed. This descriptive retrospective study, therefore, aimed to investigate the number of levofloxacin use in patients suspected TB in a community hospital in Thailand. Methods Patient medical charts of all patients who were admitted to a community hospital in Nakhon Si Thammarat, Thailand, from 2016 to 2017, were reviewed. Patients who were suspected TB and received any levofloxacin-containing regimens were included. Data on patient characteristics and the received regimens were descriptively analyzed and reported as percentage and frequency. Results There were a total of 21 patients who received levofloxacin in the hospital. Six of them (28.57%) had the diagnosis of hepatitis. The most prescribed regimen as empirical therapy was levofloxacin, ethambutol, and amikacin (66.67%). After the confirmation of TB using acid-fast bacilli (AFB) test, ten patients (47.62%) still received levofloxacin-containing regimens. Conclusion The results from this study indicated high usage of levofloxacin despite no evidence of drug-resistant TB or negative AFB results in a community hospital in Thailand. The results from this study will be further used for the investigation of the prevalence of antibiotic resistance and clinical outcomes of using second-line regimens for TB treatment.
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20
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Zawahir S, Le HTT, Nguyen TA, Beardsley J, Dang AD, Bernays S, Viney K, Cao TH, Drabarek D, Tran HH, Nguyen ST, Pham VTT, Luong TM, Tran HTM, Nguyen NV, Jan S, Marais BJ, Negin J, Marks GB, Fox GJ. Inappropriate supply of antibiotics for common viral infections by community pharmacies in Vietnam: A standardised patient survey. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 23:100447. [PMID: 35465041 PMCID: PMC9019242 DOI: 10.1016/j.lanwpc.2022.100447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study aimed to evaluate the appropriateness of antibiotic dispensing of private pharmacies in Vietnam. METHODS Standardised patient surveys were conducted in randomly selected community pharmacies across 40 districts in Vietnam. Four clinical scenarios were represented by patient actors: (a) an adult requesting treatment for a sibling with a viral upper respiratory tract infection (URTI), (b) a parent requesting treatment for a child with acute diarrhoea, (c) an adult making a direct antibiotic request, and (d) an adult presenting with an antibiotic prescription. We calculated the proportion of interactions that resulted in inappropriate supply of antibiotics and patient advice. Predictors of inappropriate antibiotic supply were assessed. FINDINGS Patient actors attended 949 pharmacies, resulting in 1266 clinical interactions. Antibiotics were inappropriately supplied to 92% (291/316) of adults requesting treatment for URTI symptoms, 43% (135/316) for children with acute diarrhoea symptoms and to 84% (267/317) of direct request for antibiotics. Only 49% of pharmacies advised patients regarding their antibiotic use. Female actors were more likely to be given antibiotics than male actors for URTI (aOR 2·71, 1·12-6·60) but not for diarrhoeal disease. Pharmacies in northern Vietnam were more likely than those in southern Vietnam to supply antibiotics without a prescription: for adult URTI (aOR=5·8, 95% CI: 2·2-14·9) and childhood diarrhoea (aOR=3·5, 95% CI: 2·0-6·0) symptoms, but less likely to dispense for direct antibiotics request. INTERPRETATION Inappropriate antibiotic supply was common in Vietnamese private pharmacies. Multifaceted measures are urgently needed to achieve WHO's global action plan for the optimal use of antimicrobials. FUNDING This study was funded by a grant from the Australian Department of Foreign Affairs and Trade.
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Affiliation(s)
- Shukry Zawahir
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | | | | | - Justin Beardsley
- The University of Sydney Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, NSW, Australia
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Sarah Bernays
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Kerri Viney
- Centre of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Research School of Population Health, Australian National University, Canberra ACT, Australia
| | - Thai Hung Cao
- Medical Service Administration, Ministry of Health, Viet Nam
| | - Dorothy Drabarek
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Hoang Huy Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | | | | | - Tan Minh Luong
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | | | | | - Stephen Jan
- The George Institute for Global Health Australia, Institute for Global Health, Sydney, Australia
| | - Ben J Marais
- The University of Sydney Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, NSW, Australia
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia
- University of New South Wales, Sydney, Australia
| | - Greg J Fox
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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21
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Bigio J, Aquilera Vasquez N, Huria L, Pande T, Creswell J, Ananthakrishnan R, Bimba JS, Cuevas LE, Vo L, Bakker MI, Rahman MT, Pai M. Engaging pharmacies in tuberculosis control: operational lessons from 19 case detection interventions in high-burden countries. BMJ Glob Health 2022; 7:bmjgh-2022-008661. [PMID: 35440442 PMCID: PMC9020292 DOI: 10.1136/bmjgh-2022-008661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/27/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jacob Bigio
- McGill International TB Centre, Montreal, Quebec, Canada .,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathaly Aquilera Vasquez
- McGill International TB Centre, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lavanya Huria
- McGill International TB Centre, Montreal, Quebec, Canada.,Department of Epidemiology and Biostatistics, McGill University Montreal, Montreal, Quebec, Canada
| | - Tripti Pande
- McGill International TB Centre, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Ramya Ananthakrishnan
- Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India
| | - John S Bimba
- Department of Community Medicine, Bingham University, Karu, Nigeria
| | - Luis E Cuevas
- Clinical Sciences and Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Luan Vo
- Friends for International TB Relief, Ha Noi, Viet Nam
| | | | | | - Madhukar Pai
- McGill International TB Centre, Montreal, Quebec, Canada.,Epidemiology and Biostats, McGill University, Montreal, Quebec, Canada
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22
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Seethalakshmi PS, Charity OJ, Giakoumis T, Kiran GS, Sriskandan S, Voulvoulis N, Selvin J. Delineating the impact of COVID-19 on antimicrobial resistance: An Indian perspective. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 818:151702. [PMID: 34798093 PMCID: PMC8592853 DOI: 10.1016/j.scitotenv.2021.151702] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/24/2021] [Accepted: 11/11/2021] [Indexed: 05/23/2023]
Abstract
The COVID-19 pandemic has shattered millions of lives globally and continues to be a challenge to public health due to the emergence of variants of concern. Fear of secondary infections following COVID-19 has led to an escalation in antimicrobial use during the pandemic, while some antimicrobials have been repurposed as treatments for SARS-CoV-2, further driving antimicrobial resistance. India is one of the largest producers and consumers of antimicrobials globally, hence the task of curbing antimicrobial resistance is a huge challenge. Practices like empirical antimicrobial prescription and repurposing of drugs in clinical settings, self-medication and excessive use of antimicrobial hygiene products may have negatively impacted the prevalence of antimicrobial resistance in India. However, the expanded production of antimicrobials and disinfectants during the pandemic in response to increased demand may have had an even greater impact on the threat of antimicrobial resistance through major impacts on the environment. The review provides an outline of the impact COVID-19 can have on antimicrobial resistance in clinical settings and the possible outcomes on the environment. This review calls for the upgrading of existing antimicrobial policies and emphasizes the need for research studies to understand the impact of the pandemic on antimicrobial resistance in India.
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Affiliation(s)
- P S Seethalakshmi
- Department of Microbiology, Pondicherry University, Puducherry 605014, India.
| | - Oliver J Charity
- NIHR Health Protection Research Unit in Healthcare associated infection and AMR, Department of Infectious Disease, Imperial College London, UK.
| | | | - George Seghal Kiran
- Department of Food Science and Technology, Pondicherry University, Puducherry 605014, India
| | - Shiranee Sriskandan
- NIHR Health Protection Research Unit in Healthcare associated infection and AMR, Department of Infectious Disease, Imperial College London, UK; MRC Centre for Molecular Bacteriology & Infection, Imperial College London, UK.
| | | | - Joseph Selvin
- Department of Microbiology, Pondicherry University, Puducherry 605014, India.
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23
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Sunjaya DK, Paskaria C, Herawati DMD, Pramayanti M, Riani R, Parwati I. Initiating a district-based public-private mix to overcome tuberculosis missing cases in Indonesia: readiness to engage. BMC Health Serv Res 2022; 22:110. [PMID: 35078467 PMCID: PMC8789543 DOI: 10.1186/s12913-022-07506-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background District-based public–private mix (DPPM) is a variant of a relatively new PPM strategy of addressing missing cases in the tuberculosis (TB) care cascade in Indonesia. We aimed to determine the readiness of various stakeholders to engage in implementing the DPPM strategy. Methods The research design was sequential exploratory mixed methods. A qualitative study in the first stage was carried out through in-depth interviews, FGD and study documents. Data were analyzed through coding, categorizing, pattern matching and theorizing. The second stage was a survey conducted using instruments built in the first stage. Data were analyzed using Rasch modeling and logistic regression. Results District TB case detection rate (CDR) has improved from 35% (2018) to 104% (2019). The contribution of private hospitals has increased considerably. However, there were almost none from the private primary healthcare facilities. The substantive theory generated indicates that awareness and concern of the TB problem, TB program comprehension and involvement, and institutional support are behind the readiness of facilities to engage the TB program (the readiness to engage). The measurement results indicate the significant correlation of all dimensions on readiness to engage. Concern of the TB problem and institutional support are variables that influence readiness to engage (p < 0.05). Conclusions Engaging private and public facility stakeholders is a challenge for local government. Intervention is through a personalized approach, encourages institutional support of health facilities for the TB program and system approach.
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Affiliation(s)
- Deni Kurniadi Sunjaya
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No 38, Bandung, West Java, 40161, Indonesia.
| | - Cindra Paskaria
- Department of Public Health, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia.,Post Graduate Program, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Dewi Marhaeni Diah Herawati
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No 38, Bandung, West Java, 40161, Indonesia
| | | | - Rini Riani
- District Health Office, City of Bandung, Bandung, Indonesia
| | - Ida Parwati
- Departement of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran; Dr. Hasan Sadikin General Hospital, Bandung, 40161, Indonesia
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24
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Yellappa V, Bindu H, Rao N, Narayanan D. Understanding dynamics of private tuberculosis pharmacy market: a qualitative inquiry from a South Indian district. BMJ Open 2022; 12:e052319. [PMID: 35074813 PMCID: PMC8788189 DOI: 10.1136/bmjopen-2021-052319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In India, retail private pharmacists (RPPs) are often patients' first point of contact for diseases, including tuberculosis (TB). We assessed the factors influencing RPPs' referral of patients with chest symptoms to the National TB Elimination Programme (NTEP) and the way business is carried out with reference to TB drugs. DESIGN We conducted semistructured interviews with a purposive sample of 41 RPPs in a South Indian district between May and October 2013. Data were collected from urban areas (21 RPPs) and rural areas (20 RPPs) employing the principle of data saturation. Data were analysed thematically using NVivo V.9. RESULTS Knowledge and compliance of RPPs regarding TB symptoms and regulatory requirements were found to be poor. The RPPs routinely dispensed medicines over the counter and less than half of the respondents had pharmacy qualifications. None of them had received TB-related training, yet half of them knew about TB symptoms. Practice of self-referrals was common particularly among economically poorer populations who preferred purchasing medicines over the counter based on RPPs' advice. Inability of patients with TB to purchase the full course of TB drugs was conspicuous. Rural RPPs were more likely to refer patients with TB symptoms to the NTEP compared with urban ones who mostly referred such clients to private practitioners (PPs). Reciprocal relationships between the RPPs, PPs, medical representatives and the prevalence of kickbacks influenced RPPs' drug-stocking patterns. PPs wielded power in this nexus, especially in urban areas. CONCLUSION India hopes to end TB by 2025. Our study findings will help the NTEP to design policy and interventions to engage RPPs in public health initiatives by taking cognisance of symbiotic relationships and power differentials that exist between PPs, RPPs and medical representatives. Concurrently, there should be a strong enforcement mechanism for existing regulatory norms regarding over-the-counter sales and record keeping.
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Affiliation(s)
- Vijayashree Yellappa
- Health Service Delivery, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
- PPP Division, NITI Aayog, Delhi, Delhi, India
| | - Himabindu Bindu
- Health Service Delivery, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Neethi Rao
- Health Service Delivery, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Devadasan Narayanan
- Health Service Delivery, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
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25
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Rosapep LA, Faye S, Johns B, Olusola-Faleye B, Baruwa EM, Sorum MK, Nwagagbo F, Adamu AA, Kwan A, Obanubi C, Atobatele AO. Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000150. [PMID: 36962145 PMCID: PMC10021846 DOI: 10.1371/journal.pgph.0000150] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria's large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus program evaluated adherence to national standards for management of presumptive and confirmed TB among the clinical facilities, laboratories, pharmacies, and drug shops it trained to deliver TB services. The study used a standardized patient (SP) survey methodology to measure case management protocol adherence among 837 private and 206 public providers in urban Lagos and Kano. It examined two different scenarios: a "textbook" case of presumptive TB and a treatment initiation case where SPs presented as referred patients with confirmed TB diagnoses. Private sector results were benchmarked against public sector results. A bottleneck analysis examined protocol adherence departures at key points along the case management sequence that providers were trained to follow. Except for laboratories, few providers met the criteria for fully correct management of presumptive TB, though more than 70% of providers correctly engaged in TB screening. In the treatment initiation case 18% of clinical providers demonstrated fully correct case management. Private and public providers' adherence was not significantly different. Bottleneck analysis revealed that the most common deviations from correct management were failure to initiate sputum collection for presumptive patients and failure to conduct sufficiently thorough treatment initiation counseling for confirmed patients. This study found the quality of private providers' TB case management to be comparable to public providers in Nigeria, as well as to providers in other high burden countries. Findings support continued efforts to include private providers in Nigeria's national TB program. Though most providers fell short of desired quality, the bottleneck analysis points to specific issues that TB stakeholders can feasibly address with system- and provider-level interventions.
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Affiliation(s)
- Lauren A Rosapep
- Abt Associates Inc., International Development Division, Rockville, MD, United States of America
| | - Sophie Faye
- Abt Associates Inc., International Development Division, Rockville, MD, United States of America
| | - Benjamin Johns
- Abt Associates Inc., International Development Division, Rockville, MD, United States of America
| | - Bolanle Olusola-Faleye
- Abt Associates Inc., Sustaining Health Outcomes through the Private Sector (SHOPS) Plus Project, Lagos, Nigeria
| | - Elaine M Baruwa
- Abt Associates Inc., International Development Division, Rockville, MD, United States of America
| | - Micah K Sorum
- Abt Associates Inc., International Development Division, Rockville, MD, United States of America
| | - Flora Nwagagbo
- Abt Associates Inc., Sustaining Health Outcomes through the Private Sector (SHOPS) Plus Project, Lagos, Nigeria
| | - Abdu A Adamu
- Abt Associates Inc., Sustaining Health Outcomes through the Private Sector (SHOPS) Plus Project, Kano, Nigeria
| | - Ada Kwan
- Division of Pulmonary and Critical Care, University of California San Francisco, San Francisco, CA, United States of America
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, CA, United States of America
| | - Christopher Obanubi
- Division of Pulmonary and Critical Care, University of California San Francisco, San Francisco, CA, United States of America
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Pineda-Antunez C, Contreras-Loya D, Rodriguez-Atristain A, Opuni M, Bautista-Arredondo S. Characterizing health care provider knowledge: Evidence from HIV services in Kenya, Rwanda, South Africa, and Zambia. PLoS One 2021; 16:e0260571. [PMID: 34855816 PMCID: PMC8638969 DOI: 10.1371/journal.pone.0260571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Identifying approaches to improve levels of health care provider knowledge in resource-poor settings is critical. We assessed level of provider knowledge for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and voluntary medical male circumcision (VMMC). We also explored the association between HTC, PMTCT, and VMMC provider knowledge and provider and facility characteristics. METHODS We used data collected in 2012 and 2013. Vignettes were administered to physicians, nurses, and counselors in facilities in Kenya (66), Rwanda (67), South Africa (57), and Zambia (58). The analytic sample consisted of providers of HTC (755), PMTCT (709), and VMMC (332). HTC, PMTCT, and VMMC provider knowledge scores were constructed using item response theory (IRT). We used GLM regressions to examine associations between provider knowledge and provider and facility characteristics focusing on average patient load, provider years in position, provider working in another facility, senior staff in facility, program age, proportion of intervention exclusive staff, person-days of training in facility, and management score. We estimated three models: Model 1 estimated standard errors without clustering, Model 2 estimated robust standard errors, and Model 3 estimated standard errors clustering by facility. RESULTS The mean knowledge score was 36 for all three interventions. In Model 1, we found that provider knowledge scores were higher among providers in facilities with senior staff and among providers in facilities with higher proportions of intervention exclusive staff. We also found negative relationships between the outcome and provider years in position, average program age, provider working in another facility, person-days of training, and management score. In Model 3, only the coefficients for provider years in position, average program age, and management score remained statistically significant at conventional levels. CONCLUSIONS HTC, PMTCT, and VMMC provider knowledge was low in Kenya, Rwanda, South Africa, and Zambia. Our study suggests that unobservable organizational factors may facilitate communication, learning, and knowledge. On the one hand, our study shows that the presence of senior staff and staff dedication may enable knowledge acquisition. On the other hand, our study provides a note of caution on the potential knowledge depreciation correlated with the time staff spend in a position and program age.
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Affiliation(s)
- Carlos Pineda-Antunez
- National Institute of Public Health (INSP), Division of Health Economics and Health Systems Innovations, Cuernavaca, Mexico
| | - David Contreras-Loya
- School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Alejandra Rodriguez-Atristain
- National Institute of Public Health (INSP), Division of Health Economics and Health Systems Innovations, Cuernavaca, Mexico
| | | | - Sergio Bautista-Arredondo
- National Institute of Public Health (INSP), Division of Health Economics and Health Systems Innovations, Cuernavaca, Mexico
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Zawahir S, Le H, Nguyen TA, Beardsley J, Duc AD, Bernays S, Viney K, Cao Hung T, McKinn S, Tran HH, Nguyen Tu S, Velen K, Luong Minh T, Tran Thi Mai H, Nguyen Viet N, Nguyen Viet H, Nguyen Thi Cam V, Nguyen Trung T, Jan S, Marais BJ, Negin J, Marks GB, Fox G. Standardised patient study to assess tuberculosis case detection within the private pharmacy sector in Vietnam. BMJ Glob Health 2021; 6:bmjgh-2021-006475. [PMID: 34615661 PMCID: PMC8496389 DOI: 10.1136/bmjgh-2021-006475] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Of the estimated 10 million people affected by (TB) each year, one-third are never diagnosed. Delayed case detection within the private healthcare sector has been identified as a particular problem in some settings, leading to considerable morbidity, mortality and community transmission. Using unannounced standardised patient (SP) visits to the pharmacies, we aimed to evaluate the performance of private pharmacies in the detection and treatment of TB. Methods A cross-sectional study was undertaken at randomly selected private pharmacies within 40 districts of Vietnam. Trained actors implemented two standardised clinical scenarios of presumptive TB and presumptive multidrug-resistant TB (MDR-TB). Outcomes were the proportion of SPs referred for medical assessment and the proportion inappropriately receiving broad-spectrum antibiotics. Logistic regression evaluated predictors of SPs’ referral. Results In total, 638 SP encounters were conducted, of which only 155 (24.3%) were referred for medical assessment; 511 (80·1%) were inappropriately offered antibiotics. A higher proportion of SPs were referred without having been given antibiotics if they had presumptive MDR-TB (68/320, 21.3%) versus presumptive TB (17/318, 5.3%; adjusted OR=4.8, 95% CI 2.9 to 7.8). Pharmacies offered antibiotics without a prescription to 89.9% of SPs with presumptive TB and 70.3% with presumptive MDR-TB, with no clear follow-up plan. Conclusions Few SPs with presumptive TB were appropriately referred for medical assessment by private pharmacies. Interventions to improve appropriate TB referral within the private pharmacy sector are urgently required to reduce the number of undiagnosed TB cases in Vietnam and similar high-prevalence settings.
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Affiliation(s)
- Shukry Zawahir
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hien Le
- Woolcock Institute of Medical Research, Kim Ma, Hanoi, Vietnam
| | - Thu Anh Nguyen
- Woolcock Institute of Medical Research, Kim Ma, Hanoi, Vietnam
| | - Justin Beardsley
- The Marie Bashir Institute, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Anh Dang Duc
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Sarah Bernays
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kerri Viney
- Centre of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Thai Cao Hung
- Medical Service Administration, Government of Viet Nam Ministry of Health, Hanoi, Vietnam
| | - Shannon McKinn
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hoang Huy Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Son Nguyen Tu
- Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Kavindhran Velen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tan Luong Minh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | - Ha Nguyen Viet
- Woolcock Institute of Medical Research, Kim Ma, Hanoi, Vietnam
| | | | | | - Stephen Jan
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Negin
- Faculty of Medicne and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Gregory Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Arinaminpathy N, Nandi A, Vijayan S, Jha N, Nair SA, Kumta S, Dewan P, Rade K, Vadera B, Rao R, Sachdeva KS. Engaging with the private healthcare sector for the control of tuberculosis in India: cost and cost-effectiveness. BMJ Glob Health 2021; 6:bmjgh-2021-006114. [PMID: 34610905 PMCID: PMC8493898 DOI: 10.1136/bmjgh-2021-006114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background The control of tuberculosis (TB) in India is complicated by the presence of a large, disorganised private sector where most patients first seek care. Following pilots in Mumbai and Patna (two major cities in India), an initiative known as the ‘Public–Private Interface Agency’ (PPIA) is now being expanded across the country. We aimed to estimate the cost-effectiveness of scaling up PPIA operations, in line with India’s National Strategic Plan for TB control. Methods Focusing on Mumbai and Patna, we collected cost data from implementing organisations in both cities and combined this data with models of TB transmission dynamics. Estimating the cost per disability adjusted life years (DALY) averted between 2014 (the start of PPIA scale-up) and 2025, we assessed cost-effectiveness using two willingness-to-pay approaches: a WHO-CHOICE threshold based on per-capita economic productivity, and a more stringent threshold incorporating opportunity costs in the health system. Findings A PPIA scaled up to ultimately reach 50% of privately treated TB patients in Mumbai and Patna would cost, respectively, US$228 (95% uncertainty interval (UI): 159 to 320) per DALY averted and US$564 (95% uncertainty interval (UI): 409 to 775) per DALY averted. In Mumbai, the PPIA would be cost-effective relative to all thresholds considered. In Patna, if focusing on adherence support, rather than on improved diagnosis, the PPIA would be cost-effective relative to all thresholds considered. These differences between sites arise from variations in the burden of drug resistance: among the services of a PPIA, improved diagnosis (including rapid tests with genotypic drug sensitivity testing) has greatest value in settings such as Mumbai, with a high burden of drug-resistant TB. Conclusions To accelerate decline in TB incidence, it is critical first to engage effectively with the private sector in India. Mechanisms such as the PPIA offer cost-effective ways of doing so, particularly when tailored to local settings.
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Affiliation(s)
- Nimalan Arinaminpathy
- Department of Infectious Disease Epidemiology, Imperial College London, London, London, UK
| | - Arindam Nandi
- Population Council, New York, New York, USA.,CDDEP, Washington, District of Columbia, USA
| | | | - Nita Jha
- World Health Partners, Patna, India
| | | | - Sameer Kumta
- Bill and Melinda Gates Foundation, India Country Office, New Delhi, India
| | - Puneet Dewan
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Kiran Rade
- World Health Organization Country Office for India, New Delhi, India
| | | | - Raghuram Rao
- National Tuberculosis Elimination Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Kuldeep S Sachdeva
- South-East Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India
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Easy Access to Antibiotics; Spread of Antimicrobial Resistance and Implementation of One Health Approach in India. J Epidemiol Glob Health 2021; 11:444-452. [PMID: 34734384 PMCID: PMC8477994 DOI: 10.1007/s44197-021-00008-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 09/14/2021] [Indexed: 11/01/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global public health concern because of its fast spread. India, one of the world's top consumer of antibiotics and second most populated country has its unique constraints of social, cultural and economic strata. The continual self-medication, use of antibiotics for the growth promotion in animals, and accumulation of residual antibiotics in the environment challenge the implementation of AMR containment policy. Hence, the present review attempts to delineate the influence of antibiotics abuse on the human, animal and environmental health under the realm of one health. It was based on the literature search using public databases to highlight the rapid surge in the burden of AMR in India affecting various sectors and/or ecosystems in India. It was found that the irrational and overuse of antibiotics in different sectors have led to the emergence of extended antimicrobial resistance wherein the environment acts as a reservoir of antibiotic resistance genes (ARGs); completing the cycle of contamination and recontamination. There are efforts by government policy makers to reduce the burden of AMR in the country to reduce the health risks, through the One Health approach. Parallel efforts in educating healthcare professionals, strict legislation for pharmacies and pharmaceutical companies should be prioritize. At the same time surveillance of newly emerged AMR pathogens, prioritising research focusing on AMR, and awareness camps or programs among the local population is critical while addressing the consequences of spared of AMR in India.
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Wulandari LPL, Khan M, Liverani M, Ferdiana A, Mashuri YA, Probandari A, Wibawa T, Batura N, Schierhout G, Kaldor J, Guy R, Law M, Day R, Hanefeld J, Parathon H, Jan S, Yeung S, Wiseman V. Prevalence and determinants of inappropriate antibiotic dispensing at private drug retail outlets in urban and rural areas of Indonesia: a mixed methods study. BMJ Glob Health 2021; 6:e004993. [PMID: 34344668 PMCID: PMC8336216 DOI: 10.1136/bmjgh-2021-004993] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/29/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION The aim of this mixed-method study was to determine the extent and determinants of inappropriate dispensing of antibiotics by licensed private drug retail outlets in Indonesia. METHODS Standardised patients (SPs) made a total of 495 visits to 166 drug outlets (community pharmacies and drug stores) between July and August 2019. The SPs presented three clinical cases to drug outlet staff: parent of a child at home with diarrhoea; an adult with presumptive tuberculosis (TB); and an adult with upper respiratory tract infection (URTI). The primary outcome was the dispensing of an antibiotic without prescription, with or without the client requesting it. We used multivariable random effects logistic regression to assess factors associated with the primary outcome and conducted 31 interviews with drug outlet staff to explore these factors in greater depth. RESULTS Antibiotic dispensing without prescription occurred in 69% of SP visits. Dispensing antibiotics without a prescription was more likely in standalone pharmacies and pharmacies attached to clinics compared with drug stores, with an OR of 5.9 (95% CI 3.2 to 10.8) and OR of 2.2 (95% CI 1.2 to 3.9); and more likely for TB and URTI SP-performed cases compared with child diarrhoea cases, with an OR of 5.7 (95% CI 3.1 to 10.8) and OR of 5.2 (95% CI 2.7 to 9.8). Interviews revealed that inappropriate antibiotic dispensing was driven by strong patient demand for antibiotics, unqualified drug sellers dispensing medicines, competition between different types of drug outlets, drug outlet owners pushing their staff to sell medicines, and weak enforcement of regulations. CONCLUSION This study shows that inappropriate dispensing of antibiotics by private drug retail outlets is widespread. Interventions will need to address not only the role of drug sellers, but also the demand for antibiotics among clients and the push from drug outlet owners to compete with other outlets.
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Affiliation(s)
- Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia
| | - Mishal Khan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Pathology & Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Astri Ferdiana
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Mataram, Mataram, Nusa Tenggara Barat, Indonesia
| | - Yusuf Ari Mashuri
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
| | - Ari Probandari
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
| | - Tri Wibawa
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Neha Batura
- Institute for Global Health, University College London, London, UK
| | - Gill Schierhout
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Day
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Harry Parathon
- Antibiotic Resistance Control Committee, Indonesian Ministry of Health, Jakarta, Indonesia
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - Shunmay Yeung
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Parthasarathi A, Puvvada R, Patel H, Bhandari P, Nagpal S. Evaluation of Medication Errors in a Tertiary Care Hospital of a Low- to Middle-Income Country. Cureus 2021; 13:e16769. [PMID: 34354894 PMCID: PMC8328840 DOI: 10.7759/cureus.16769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Medication errors (MEs) are a major public health concern as they are detrimental to patient safety, compromise patients' confidence in the healthcare system, increase healthcare costs, and adversely affect the patient's quality of life. This is especially true in low to middle-income countries where the significance of MEs is largely undervalued. This study aims to investigate the prevalence of MEs and analyze the causes, medicines involved, reporting, and severity of MEs in a tertiary care setting. Methods A prospective observational study was conducted from March 2020 to February 2021 in a tertiary care teaching hospital in South India. The data was collected after reviewing patient medical records, by interviewing patients and healthcare professionals. National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index was used to evaluate MEs. Results A total of 557 MEs were identified from 3798 patients with a prevalence of 14.6%. Prescribing errors were the most commonly observed ME followed by errors related to documentation of medical records, administration-related errors, and dispensing errors. Lack of time for documentation of medication records, shift change and work overload were common causes of MEs. The majority of MEs were category A and B of the NCC MERP severity index. Conclusion Antibiotics and proton pump inhibitors were the most common medicines involved in MEs. Prescribing and documentation errors were most prevalent. Implementation of systems like strict adherence to treatment guidelines, computerized provider order entry (CPOE), barcode medication administration, and closed-loop electronic medication management systems may greatly help reduce MEs. All healthcare institutions should undertake routine audits to determine the prevalence and causes of medication errors.
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Affiliation(s)
| | - Rahul Puvvada
- Physiology, Anatomy, and Microbiology, College of Science, Health and Engineering, La Trobe University, Melbourne, AUS
| | - Himanshu Patel
- Pharmacology and Therapeutics, International Society of Oncology Pharmacy Practitioners, North Vancouver, CAN
| | - Pooja Bhandari
- Public Health, Madhavnagar Government Hospital, Ujjain, IND
| | - Sagar Nagpal
- Internal Medicine, Erie County Medical Center, Buffalo, USA
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Sulis G, Daniels B, Kwan A, Gandra S, Daftary A, Das J, Pai M. Antibiotic overuse in the primary health care setting: a secondary data analysis of standardised patient studies from India, China and Kenya. BMJ Glob Health 2021; 5:bmjgh-2020-003393. [PMID: 32938614 PMCID: PMC7493125 DOI: 10.1136/bmjgh-2020-003393] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Determining whether antibiotic prescriptions are inappropriate requires knowledge of patients’ underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse, as the research design involves patients with predefined conditions. Methods Secondary analyses of data from nine SP studies were performed to estimate the proportion of SP–provider interactions resulting in inappropriate antibiotic prescribing across primary care settings in three LMICs (China, India and Kenya). In all studies, SPs portrayed conditions for which antibiotics are unnecessary (watery diarrhoea, presumptive tuberculosis (TB), angina and asthma). We conducted descriptive analyses reporting overall prevalence of antibiotic overprescribing by healthcare sector, location, provider qualification and case. The WHO Access–Watch–Reserve framework was used to categorise antibiotics based on their potential for selecting resistance. As richer data were available from India, we examined factors associated with antibiotic overuse in that country through hierarchical Poisson models. Results Across health facilities, antibiotics were given inappropriately in 2392/4798 (49.9%, 95% CI 40.8% to 54.5%) interactions in India, 83/166 (50.0%, 95% CI 42.2% to 57.8%) in Kenya and 259/899 (28.8%, 95% CI 17.8% to 50.8%) in China. Prevalence ratios of antibiotic overuse in India were significantly lower in urban versus rural areas (adjusted prevalence ratio (aPR) 0.70, 95% CI 0.52 to 0.96) and higher for qualified versus non-qualified providers (aPR 1.55, 95% CI 1.42 to 1.70), and for presumptive TB cases versus other conditions (aPR 1.19, 95% CI 1.07 to 1.33). Access antibiotics were predominantly used in Kenya (85%), but Watch antibiotics (mainly quinolones and cephalosporins) were highly prescribed in India (47.6%) and China (32.9%). Conclusion Good-quality SP data indicate alarmingly high levels of antibiotic overprescription for key conditions across primary care settings in India, China and Kenya, with broad-spectrum agents being excessively used in India and China.
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Affiliation(s)
- Giorgia Sulis
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.,McGill International TB Centre, McGill University, Montreal, Québec, Canada
| | - Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Ada Kwan
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Medicine, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, York University, Toronto, Ontario, Canada.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA.,Centre for Policy Research, New Delhi, Delhi, India
| | - Madhukar Pai
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada .,McGill International TB Centre, McGill University, Montreal, Québec, Canada.,Manipal McGill Program for Infectious Diseases, Manipal Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Use of simulated patients to assess hypertension case management at public healthcare facilities in South Africa. J Hypertens 2021; 38:362-367. [PMID: 31584515 DOI: 10.1097/hjh.0000000000002258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Our study aims to evaluate hypertensive case management in South Africa's public health sector using simulated patients. METHOD Our study describes interactions between hypertensive simulated patients and primary healthcare workers at 39 public sector healthcare facilities in two metropolitan centres in the Eastern and Western Cape Provinces of South Africa. Our analysis focus on 97 interactions where our eight simulated patients tested within range for stage 1 hypertension, that is with SBP 140-159 mmHg and/or DBP 90-99 mmHg. For this subset, we describe how healthcare workers communicated the outcome of the blood pressure test, and whether they follow government guidelines on risk assessment and lifestyle advice. RESULTS Healthcare workers highlighted the risks associated with hypertension in one out of three cases and stressed the importance of regular monitoring of blood pressure in less than half of cases. Hypertensive patients received advice on all six lifestyle risk factors in 8% of cases. 39% of patients received no lifestyle advice at all. In one out of four cases, hypertensive patients left the facility without a hypertension diagnosis and with no prospect of a follow-up visit. CONCLUSION Simulated patients can assess the quality of hypertension case management, yielding granular and comprehensive information that can help mobilize resources to improve care. The management of hypertension patients in South African public healthcare facilities is critically insufficient. Given that hypertension is responsible for a rising share of deaths in South Africa and many of these deaths are preventable, urgent intervention is needed.
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Wang J, Gong Y, Wu J, Jiang N, Chen Z, Yin X. Antibiotic dispensing patterns and patient interventions for upper respiratory tract infections by hospitals and retail pharmacies: A cross-sectional study based on standardized patients. Soc Sci Med 2021; 272:113729. [PMID: 33556812 DOI: 10.1016/j.socscimed.2021.113729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/19/2020] [Accepted: 01/25/2021] [Indexed: 11/18/2022]
Abstract
Hospitals and retail pharmacies are the two main sources of antibiotics for the public. This study aimed to compare the antibiotics dispensing patterns between these two types of institutions, and to assess the impact of patient behavior on the dispensing of antibiotics. A cross-sectional survey was conducted in Hubei Province, China, from June 2015 to August 2016. Standardized patients were recruited to simulate upper respiratory tract infections (URTI), presenting three different patient states to physicians and pharmacy staff. We collected a total of 378 cases in hospital and investigated 300 retail pharmacies. Hospitals dispensed a higher proportion of antibiotics compared with retail pharmacies in the cases of no patient intervention (59.50% vs. 33.00%). In the hospitals, compared with non-intervention group, the relative risks of antibiotics dispensing in patient request group was 1.12 (95%CI: 0.93-1.35) and that in patient knowledge expressing group was 0.59 (95%CI: 0.44-0.78). In retail pharmacies, 44.78% of the pharmacies changed the antibiotic dispensing behavior after the patient requested it, whereas 32.32% of the pharmacies no longer sold antibiotics after the patient expressed knowledge. β-Lactam broad-spectrum antibiotics were the most widely distributed drugs in both hospitals and retail pharmacies. The pharmaceutical services provided by hospitals was significantly superior to that of retail pharmacies (P < 0.05). The irrational use of antibiotics is common in patients with URTI both in hospitals and retail pharmacies and is susceptible to patients' influence. The quality of pharmaceutical services in both institutions needs to be improved.
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Affiliation(s)
- Jing Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jianxiong Wu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Nan Jiang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Zhenyuan Chen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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Fu H, Lewnard JA, Frost I, Laxminarayan R, Arinaminpathy N. Modelling the global burden of drug-resistant tuberculosis avertable by a post-exposure vaccine. Nat Commun 2021; 12:424. [PMID: 33462224 PMCID: PMC7814030 DOI: 10.1038/s41467-020-20731-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/16/2020] [Indexed: 11/09/2022] Open
Abstract
There have been notable advances in the development of vaccines against active tuberculosis (TB) disease for adults and adolescents. Using mathematical models, we seek to estimate the potential impact of a post-exposure TB vaccine, having 50% efficacy in reducing active disease, on global rifampicin-resistant (RR-) TB burden. In 30 countries that together accounted for 90% of global RR-TB incidence in 2018, a future TB vaccine could avert 10% (95% credible interval: 9.7-11%) of RR-TB cases and 7.3% (6.6-8.1%) of deaths over 2020-2035, with India, China, Indonesia, Pakistan, and the Russian Federation having the greatest contribution. This impact would increase to 14% (12-16%) and 31% (29-33%) respectively, when combined with improvements in RR-TB diagnosis and treatment relative to a scenario of no vaccine and no such improvements. A future TB vaccine could have important implications for the global control of RR-TB, especially if implemented alongside enhancements in management of drug resistance.
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Affiliation(s)
- Han Fu
- MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, W2 1PG, UK.
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Isabel Frost
- Center for Disease Dynamics, Economics & Policy, New Delhi, India
- Department of Infectious Disease, Imperial College London, London, W2 1NY, UK
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi, India
- Princeton University, Princeton, NJ, 08544, USA
| | - Nimalan Arinaminpathy
- MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, W2 1PG, UK
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Batista AD, A. Rodrigues D, Figueiras A, Zapata-Cachafeiro M, Roque F, Herdeiro MT. Antibiotic Dispensation without a Prescription Worldwide: A Systematic Review. Antibiotics (Basel) 2020; 9:E786. [PMID: 33171743 PMCID: PMC7694985 DOI: 10.3390/antibiotics9110786] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/31/2020] [Accepted: 11/06/2020] [Indexed: 01/10/2023] Open
Abstract
Antibiotic resistance still remains a major global public health problem and the dispensing of antibiotics without a prescription at community pharmacies is an important driver of this. MEDLINE, Pubmed and EMBASE databases were used to search and identify studies reporting the dispensing of non-prescribed antibiotics in community pharmacies or drugstores that sell drugs for human use, by applying pharmacy interviews/questionnaires methods and/or simulated patient methods. Of the 4683 studies retrieved, 85 were included, of which 59 (69.4%) were published in low-and middle-income countries. Most of the papers (83.3%) presented a percentage of antibiotic dispensing without a prescription above 60.0%. Sixty-one studies evaluated the active substance and the most sold antibiotics without a prescription were amoxicillin (86.9%), azithromycin (39.3%), ciprofloxacin (39.3%), and amoxicillin-clavulanic acid (39.3%). Among the 65 articles referencing the diseases/symptoms, this practice was shown to be mostly associated with respiratory system problems (100.0%), diarrhea (40.0%), and Urinary Tract Infections (30.8%). In sum, antibiotics are frequently dispensed without a prescription in many countries and can thus have an important impact on the development of resistance at a global level. Our results indicate the high need to implement educational and/or regulatory/administrative strategies in most countries, aiming to reduce this practice.
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Affiliation(s)
- Ana Daniela Batista
- Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Daniela A. Rodrigues
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), 6300-559 Guarda, Portugal; (D.A.R.); (F.R.)
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain; (A.F.); (M.Z.-C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), 28001 Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15702 Santiago de Compostela, Spain
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain; (A.F.); (M.Z.-C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), 28001 Madrid, Spain
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), 6300-559 Guarda, Portugal; (D.A.R.); (F.R.)
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
| | - Maria Teresa Herdeiro
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
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Law I, Floyd K. National tuberculosis prevalence surveys in Africa, 2008-2016: an overview of results and lessons learned. Trop Med Int Health 2020; 25:1308-1327. [PMID: 32910557 DOI: 10.1111/tmi.13485] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE AND METHODS Worldwide, tuberculosis (TB) is the leading cause of death from a single infectious agent. In many countries, national TB prevalence surveys are the only way to reliably measure the burden of TB disease and can also provide other evidence to inform national efforts to improve TB detection and treatment. Our objective was to synthesise the results and lessons learned from national surveys completed in Africa between 2008 and 2016, to complement a previous review for Asia. RESULTS Twelve surveys completed in Africa were identified: Ethiopia (2010-2011), Gambia (2011-2013), Ghana (2013), Kenya (2015-2016), Malawi (2013-2014), Nigeria (2012), Rwanda (2012), Sudan (2013-2014), Tanzania (2011-2012), Uganda (2014-2015), Zambia (2013-2014) and Zimbabwe (2014). The eligible population in all surveys was people aged ≥15 years who met residency criteria. In total 588 105 individuals participated, equivalent to 82% (range 57-96%) of those eligible. The prevalence of bacteriologically confirmed pulmonary TB disease in those ≥15 years varied from 119 (95% CI 79-160) per 100 000 population in Rwanda and 638 (95% CI 502-774) per 100 000 population in Zambia. The male:female ratio was 2.0 overall, ranging from 1.2 (Ethiopia) to 4.1 (Uganda). Prevalence per 100 000 population generally increased with age, but the absolute number of cases was usually highest among those aged 35-44 years. Of identified TB cases, 44% (95% CI 40-49) did not report TB symptoms during screening and were only identified as eligible for diagnostic testing due to an abnormal chest X-ray. The overall ratio of prevalence to case notifications was 2.5 (95% CI 1.8-3.2) and was consistently higher for men than women. Many participants who did report TB symptoms had not sought care; those that had were more likely to seek care in a public health facility. HIV prevalence was systematically lower among prevalent cases than officially notified TB patients with an overall ratio of 0.5 (95% CI 0.3-0.7). The two main study limitations were that none of the surveys included people <15 years, and 5 of 12 surveys did not have data on HIV status. CONCLUSIONS National TB prevalence surveys implemented in Africa between 2010 and 2016 have contributed substantial new evidence about the burden of TB disease, its distribution by age and sex, and gaps in TB detection and treatment. Policies and practices to improve access to health services and reduce under-reporting of detected TB cases are needed, especially among men. All surveys provide a valuable baseline for future assessment of trends in TB disease burden.
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Affiliation(s)
- Irwin Law
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Katherine Floyd
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
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Ullah W, Almansour H, Fatima R, Saini B, Khan GM. Engaging Community Pharmacies in Early Detection of Missing Tuberculosis Patients through Public-Private Mix Intervention in Pakistan. Am J Trop Med Hyg 2020; 103:221-230. [PMID: 32372744 DOI: 10.4269/ajtmh.19-0939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Globally, Pakistan ranks fifth in terms of missing tuberculosis (TB) patients' burden. Missed TB cases are either undiagnosed or diagnosed but not notified to the national TB database. Public-private mix interventions are contributing significantly to the case detection, diagnosis, and treatment of TB in Pakistan. However, it is estimated that many cases of infected TB patients go undetected. It is likely that these "undiagnosed" active TB cases seek treatment from community pharmacies, among other venues. This study aimed at assessing the feasibility of community pharmacy-based TB case detection. Case detection protocol implementation in three Pakistani districts in a nonrandom selection of pharmacies was followed by a review of routinely maintained prospective records of patients referred from these private community pharmacies to general practitioner (GP) clinics. The study engaged 500 community pharmacies for referring presumptive TB patients to GP clinics. In total, 85% of the engaged pharmacies remained active in providing referrals during the study period. The community pharmacy-referral network achieved an annual referral rate of 3,025 presumptive TB patients and identified 547 active TB cases for the period January-December 2017. Every fifth referral among presumptives presenting and counseled at pharmacies was diagnosed with TB at GP clinics. This contribution was 9% of all new TB cases identified in these districts through all other private venues linked with the Greenstar Social Marketing setup. Identified barriers and facilitators to implementation and cost effectiveness of pharmacy models for TB case detection should be considered if the model were to be scaled up.
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Affiliation(s)
- Waseem Ullah
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Greenstar Social Marketing Pakistan Guarantee Limited, Lahore, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Hadi Almansour
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Razia Fatima
- Chief Research Unit, National Tuberculosis Control Program, Islamabad, Pakistan
| | - Bandana Saini
- The Woolcock Institute of Medical Research, Sydney, Australia.,School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Shi L, Chang J, Liu X, Zhai P, Hu S, Li P, Hayat K, Kabba JA, Feng Z, Yang C, Jiang M, Zhao M, Hu H, Fang Y. Dispensing Antibiotics without a Prescription for Acute Cough Associated with Common Cold at Community Pharmacies in Shenyang, Northeastern China: A Cross-Sectional Study. Antibiotics (Basel) 2020; 9:E163. [PMID: 32268530 PMCID: PMC7235837 DOI: 10.3390/antibiotics9040163] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 01/21/2023] Open
Abstract
: The inappropriate use of antibiotics is a major health issue in China. We aimed to assess nonprescription antibiotic dispensing and assess pharmacy service practice at community pharmacies in Shenyang, northeastern China, and to compare these practices between pediatric and adult cases. A cross-sectional study was performed from March to May 2018 using the standardized client method. Two different simulated scenarios were presented at pharmacies, namely, pediatric and adult acute cough associated with a common cold. Of 150 pharmacy visits, 147 visits were completed (pediatric case: 73, adult case: 74). A total of 130 (88.4%) community pharmacies dispensed antibiotics without a prescription, with a significant difference between pediatric and adult cases (pediatric case, 79.5% versus adult case, 97.3%, p = 0.005). Symptoms were asked in most visits (pediatric case: 82.2%, adult case 82.4%). Patients' previous treatment and history of allergies were both inquired more frequently in the pediatric cases than in the adult cases. Medication advice was provided more often in the adult cases than in pediatric cases. Antibiotics were easily obtained without a prescription in Shenyang, especially for adult patients. Adequate inquiries and counseling had not occurred in most pharmacies.
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Affiliation(s)
- Li Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Xiaoxi Liu
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang 110016 China;
| | - Panpan Zhai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Shuchen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Zhitong Feng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa 999078, Macao, China;
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
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Saria V. New Machine, Old Cough: Technology and Tuberculosis in Patna. FRONTIERS IN SOCIOLOGY 2020; 5:18. [PMID: 33869427 PMCID: PMC8022787 DOI: 10.3389/fsoc.2020.00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/27/2020] [Indexed: 06/12/2023]
Abstract
In 2013, a new technology, GeneXpert, was introduced in India, which, in addition to testing for TB, could also diagnose whether the detected strain was drug resistant. By detecting the bacterium more effectively than other available tests and simultaneously testing for resistance, GeneXpert promised to reduce the delay in diagnosis and hence ineffective treatments. The new test was introduced to multiple cities via a coalition that included global health funding bodies, the government of India, the World Health Organization, and non-governmental organizations. Despite the concerted effort of the coalition, among formal providers (those trained in biomedicine) in the private sector, the new technology was not adopted as quickly as had been hoped. Examining formal providers' initial responses to the technology's introduction in the city of Patna reveals how the adoption of new technology can be influenced by the particularities of the local medical market such as the availability of diagnostic tests, presence of informal providers, and reputation of formal providers. While protocols and operations might seem standardized across implementation plans, the work that is required to ensure success must take into account the particular role that the market plays from site to site.
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Affiliation(s)
- Vaibhav Saria
- Department of Gender, Sexuality, and Women's Studies, Simon Fraser University, Burnaby, BC, Canada
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42
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Godman B, Haque M, McKimm J, Abu Bakar M, Sneddon J, Wale J, Campbell S, Martin AP, Hoxha I, Abilova V, Anand Paramadhas BD, Mpinda-Joseph P, Matome M, de Lemos LLP, Sefah I, Kurdi A, Opanga S, Jakupi A, Saleem Z, Hassali MA, Kibuule D, Fadare J, Bochenek T, Rothe C, Furst J, Markovic-Pekovic V, Bojanić L, Schellack N, Meyer JC, Matsebula Z, Phuong TNT, Thanh BN, Jan S, Kalungia A, Mtapuri-Zinyowera S, Sartelli M, Hill R. Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future. Curr Med Res Opin 2020; 36:301-327. [PMID: 31794332 DOI: 10.1080/03007995.2019.1700947] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use.Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known.Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals.Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Health Economics Centre, University of Liverpool, Liverpool, UK
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Wales UK
| | - Muhamad Abu Bakar
- Unit of Otolaryngology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | | | - Janney Wale
- Independent Consumer Advocate, Brunswick, Victoria, Australia
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Antony P Martin
- Health Economics Centre, University of Liverpool, Liverpool, UK
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Vafa Abilova
- Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan Republic
| | | | - Pinkie Mpinda-Joseph
- Department of Infection Prevention and Control, Nyangabgwe Hospital, Francistown, Botswana
| | | | - Livia Lovato Pires de Lemos
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Campus Pampulha, Minas Gerais, CEP, Brazil
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, CEP, Brazil
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Sylvia Opanga
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan
| | | | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Celia Rothe
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Jurij Furst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Vanda Markovic-Pekovic
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Ljubica Bojanić
- Public Health Institute, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Thuy Nguyen Thi Phuong
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Saira Jan
- Department of Clinical Pharmacy, Rutgers State University of New Jersey, Piscataway, NJ, USA
- Department of Pharmacy Strategy and Clinical Integration, Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, USA
| | - Aubrey Kalungia
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | | | - Massimo Sartelli
- Department of Surgery, University of Macerata, Macerata Hospital, Macerata, MC, Italy
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, UK
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Shibu V, Daksha S, Rishabh C, Sunil K, Devesh G, Lal S, Jyoti S, Kiran R, Bhavin V, Amit K, Radha T, Sandeep B, Minnie K, Kaur GR, Vaishnavi J, Sudip M, Sameer K, Achutan NS, Sanjeev K, Puneet D. Tapping private health sector for public health program? Findings of a novel intervention to tackle TB in Mumbai, India. Indian J Tuberc 2020; 67:189-201. [PMID: 32553311 DOI: 10.1016/j.ijtb.2020.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND India carries one-fourth of the global tuberculosis (TB) burden. Hence the country has drafted the ambitious National Strategic Plan to eliminate tuberculosis by 2025. To realise this goal, India's Revised National Tuberculosis Control Programme (RNTCP) and partners piloted a novel strategy to engage private-providers for tuberculosis care via a "Private-provider Interface Agency" (PPIA) in Mumbai and other locations. INTERVENTION The program mapped and engaged private-providers, chemists, and laboratories; facilitated TB notification via call centers and field staff; provided free tuberculosis diagnostic tests and anti-TB drugs using novel electronic vouchers; monitored quality of care; and supported patients to ensure anti-TB treatment adherence and completion. This report summarises the descriptive analysis of PPIA implementation data piloted in Mumbai from 2014 to 2017. FINDINGS The program mapped 8789 private doctors, 3438 chemists, and 985 laboratories. Of these, 3836 (44%) doctors, 285 (29%) laboratories, and 353 (10%) chemists were prioritized and engaged in the program. Over three and a half years, the program recorded 60,366 privately-notified tuberculosis patients, of which, 24,146 (40%) were microbiologically-confirmed, 5203 (9%) were rifampicin-resistant, and 4401 (7%) were paediatric TB patients. Mumbai's annual total TB case notification rate increased from a pre-program baseline of 272 per 100,000/year in 2013 to 416 per 100,000/year in 2017. Overall, 42,300 (78%) patients completed the TB treatment, and 4979 (9%) could not be evaluated. INTERPRETATION The PPIA program in Mumbai demonstrated that private-providers can be effectively engaged for TB control in urban India. This program has influenced national policy and has been adapted and funded for a country-wide scale up. The model may also be considered in conditions where private-provider engagement is needed to improve access and quality of care for any area of public health.
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Affiliation(s)
| | - Shah Daksha
- Department of Health, Muncipal Corporation of Greater Mumbai, India
| | | | - Khaparde Sunil
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Gupta Devesh
- Central TB Division, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | | | | | - Rade Kiran
- World Health Organization, New Delhi, India
| | | | - Karad Amit
- World Health Organization, New Delhi, India
| | | | | | - Khetrapal Minnie
- Department of Health, Muncipal Corporation of Greater Mumbai, India
| | | | | | | | - Kumta Sameer
- Bill & Melinda Gates Foundation, New Delhi, India
| | | | | | - Dewan Puneet
- Independent Public Health Consultant, Seattle, WA, USA
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Xue H, Shi Y, Huang L, Yi H, Zhou H, Zhou C, Kotb S, Tucker JD, Sylvia SY. Diagnostic ability and inappropriate antibiotic prescriptions: a quasi-experimental study of primary care providers in rural China. J Antimicrob Chemother 2020; 74:256-263. [PMID: 30285113 DOI: 10.1093/jac/dky390] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/28/2018] [Indexed: 12/20/2022] Open
Abstract
Background China has one of the highest rates of antibiotic resistance. Existing studies document high rates of antibiotic prescription by primary care providers but there is little direct evidence on clinically inappropriate use of antibiotics or the drivers of antibiotic prescription. Methods To assess clinically inappropriate antibiotic prescriptions among rural primary care providers, we employed unannounced standardized patients (SPs) who presented three fixed disease cases, none of which indicated antibiotics. We compared antibiotic prescriptions of the same providers in interactions with SPs and matching vignettes assessing knowledge of diagnosis and treatment to assess overprescription attributable to deficits in diagnostic knowledge, therapeutic knowledge and factors that lead providers to deviate from their knowledge of best practice. Results Overall, antibiotics were inappropriately prescribed in 221/526 (42%) SP cases. Compared with SP interactions, prescription rates were 29% lower in matching clinical vignettes (42% versus 30%, P < 0.0001). Compared with vignettes assessing diagnostic and therapeutic knowledge jointly, rates were 67% lower in vignettes with the diagnosis revealed (30% versus 10%, P < 0.0001). Antibiotic prescription in vignettes was inversely related to measures of diagnostic process quality (completion of checklists). Conclusions Clinically inappropriate antibiotic prescription is common among primary care providers in rural China. While a large proportion of overprescription may be due to factors such as financial incentives tied to drug sales and perceived patient demand, our findings suggest that deficits in diagnostic knowledge are a major driver of unnecessary antibiotic prescriptions. Interventions to improve diagnostic capacity among providers in rural China are needed.
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Affiliation(s)
- Hao Xue
- School of Economics and Management, Northwest University, Xi'an, Shaanxi, China
| | - Yaojiang Shi
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Lei Huang
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Hongmei Yi
- School of Advanced Agricultural Sciences, Peking University, Beijing, China
| | - Huan Zhou
- Department of Health and Social Behavior, West China School of Public Health, Sichuan University, Chengdu, China
| | - Chengchao Zhou
- Institute of Social Medicine and Health Administration, School of Public Health, Shandong University, Jinan, China
| | - Sarah Kotb
- Stanford Law School, Stanford University, Stanford, CA, USA
| | - Joseph D Tucker
- University of North Carolina Project China, Guangdong, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Sean Y Sylvia
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Quality of tuberculosis care by pharmacies in low- and middle-income countries: Gaps and opportunities. J Clin Tuberc Other Mycobact Dis 2019; 18:100135. [PMID: 31872080 PMCID: PMC6911950 DOI: 10.1016/j.jctube.2019.100135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pharmacies hold great potential to contribute meaningfully to tuberculosis (TB) control efforts, given their accessibility and extensive utilisation by communities in many high burden countries. Despite this promise, the quality of care provided by pharmacies in these settings for a range of conditions has historically been poor. This paper sets out to conceptualise the key issues surrounding quality of TB care in the low- and middle-income country pharmacy setting; examine the empirical evidence on quality of care; and review the interventions employed to improve this. A number of quality challenges are apparent in relation to anti-TB medicine availability, pharmacopeial quality of anti-TB medicines stocked, pharmacy workers’ knowledge, and management of patients both prior to and following diagnosis. Poor management practices include inadequate questioning of symptomatic patients, lack of referral for testing, over-the-counter sale of anti-TB medication as well as unnecessary and harmful medicines (e.g., antibiotics and steroids), and insufficient counselling. Interventions to improve pharmacy practice in relation to TB control have all fallen under the umbrella of public-private mix (PPM) initiatives, whereby pharmacies are engaged into national TB programmes to improve case detection. These interventions all involved training of pharmacists to refer symptomatic patients for testing and have enjoyed reasonable success, although achieving scale remains a challenge. Future interventions would do well to expand their focus beyond case detection to also improve counselling of patients and inappropriate medicine sales. The lack of pharmacy-specific global guidelines and the regulatory environment were identified as key areas for future attention.
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Assessment of non-prescription antibiotic dispensing at community pharmacies in China with simulated clients: a mixed cross-sectional and longitudinal study. THE LANCET. INFECTIOUS DISEASES 2019; 19:1345-1354. [DOI: 10.1016/s1473-3099(19)30324-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 05/29/2019] [Accepted: 06/07/2019] [Indexed: 12/22/2022]
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Dabas H, Deo S, Sabharwal M, Pal A, Salim S, Nair L, Chauhan K, Maheshwari P, Parulkar A, Singh R, Chitalia M, Kadam R, Kaur M, Oghor C, Ponnudurai N, Kumta S, Small P, Dewan P, Pai M. Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT): a market-shaping intervention in India. BMJ Glob Health 2019; 4:e001539. [PMID: 31908854 PMCID: PMC6936393 DOI: 10.1136/bmjgh-2019-001539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/19/2019] [Accepted: 10/25/2019] [Indexed: 11/04/2022] Open
Abstract
A majority of patients with tuberculosis (TB) in India are diagnosed and treated in the private sector. Yet, most private providers do not use most recent WHO-endorsed microbiological tests such as liquid cultures, line probe assays and Xpert MTB/RIF due to a combination of factors such as lack of awareness, misaligned incentives and high prices that are unaffordable for patients. We designed a market-based approach to transform a high-price, low-volume market equilibrium into a low-price, high-volume equilibrium to improve the uptake of these tests. Toward this end, a non-profit consortium of private laboratories, called Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT) was formed in India in March 2013. It negotiated lower pricing on equipment and reagents with manufacturers, closer to that offered to the public sector. In return, IPAQT assured that this discount was passed on to patients, who typically paid for these tests out of their pockets, through an informally agreed on retail ceiling price. IPAQT also invested in demand generation activities that complemented the supply-side effort. IPAQT membership grew from 56 laboratories in 2013 to 211 in 2018. During this period, the initiative resulted in a 10-fold increase in the uptake of Xpert and a 30%-50% reduction in price. This initiative is planned to be expanded to other South Asian countries with similar TB epidemic and private market structure and dynamics. However, long-term sustainability of the initiative would require developing more cost-effective marketing activities and integration with broader private sector engagement agenda of the national TB programme.
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Affiliation(s)
| | - Sarang Deo
- Operations Management, Indian School of Business, Hyderabad, India
| | | | - Arnab Pal
- Clinton Health Access Initiative, New Delhi, India
| | - Sachin Salim
- Clinton Health Access Initiative, New Delhi, India
| | - Lakshmi Nair
- Clinton Health Access Initiative, New Delhi, India
| | | | | | | | - Ritu Singh
- Clinton Health Access Initiative, New Delhi, India
| | | | | | - Manjot Kaur
- Clinton Health Access Initiative, New Delhi, India
| | - Collins Oghor
- Epidemiology and Biostats, McGill University, Montreal, Quebec, Canada
| | - Nirros Ponnudurai
- Epidemiology and Biostats, McGill University, Montreal, Quebec, Canada
| | - Sameer Kumta
- Bill and Melinda Gates Foundation, New Delhi, India
| | - Peter Small
- Bill and Melinda Gates Foundation, New Delhi, India
| | - Puneet Dewan
- Bill and Melinda Gates Foundation, New Delhi, India
| | - Madhukar Pai
- Epidemiology and Biostats, McGill University, Montreal, Quebec, Canada
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Nafade V, Huddart S, Sulis G, Daftary A, Miraj SS, Saravu K, Pai M. Over-the-counter antibiotic dispensing by pharmacies: a standardised patient study in Udupi district, India. BMJ Glob Health 2019; 4:e001869. [PMID: 31798998 PMCID: PMC6861094 DOI: 10.1136/bmjgh-2019-001869] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/28/2019] [Accepted: 10/05/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is a global health emergency, and one of the contributing factors is overuse and misuse of antibiotics. India is one of the world's largest consumers of antibiotics, and inappropriate use is potentially widespread. This study aimed to use standardised patients (SPs) to measure over-the-counter antibiotic dispensing in one region. METHODS Three adults from the local community in Udupi, India, were recruited and trained as SPs. Three conditions, in both adults and children, were considered: diarrhoea, upper respiratory tract infection and acute fever. Adult SPs were used as proxies for the paediatric cases. RESULTS A total of 1522 SP interactions were successfully completed from 279 pharmacies. The proportion of SP interactions resulting in the provision of an antibiotic was 4.34% (95% CI 3.04% to 6.08%) for adult SPs and 2.89% (95% CI 1.8% to 4.4%) for child SPs. In the model, referral to another provider was associated with an OR 0.38 (95% CI 0.18 to 0.79), the number of questions asked was associated with an OR 1.54 (95% CI 1.30 to 1.84) and an SP-pharmacist interaction lasting longer than 3 min was associated with an OR 3.03 (95% CI 1.11 to 8.27) as compared with an interaction lasting less than 1 min. CONCLUSION Over-the-counter antibiotic dispensing rate was low in Udupi district and substantially lower than previously published SP studies in other regions of India. Dispensing was lowest when pharmacies referred to a doctor, and higher when pharmacies asked more questions or spent more time with clients.
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Affiliation(s)
- Vaidehi Nafade
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- McGill International Tuberculosis Center, McGill University, Montreal, Québec, Canada
| | - Sophie Huddart
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- McGill International Tuberculosis Center, McGill University, Montreal, Québec, Canada
| | - Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- McGill International Tuberculosis Center, McGill University, Montreal, Québec, Canada
| | - Amrita Daftary
- Faculty of Health, York university, Toronto, Ontario, Canada
| | - Sonal Sekhar Miraj
- Department of Pharmacy Parctice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Manipal McGill Program for Infectious Diseases, Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
| | - Kavitha Saravu
- Manipal McGill Program for Infectious Diseases, Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
- Department of Infectious Diseases, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- McGill International Tuberculosis Center, McGill University, Montreal, Québec, Canada
- Manipal McGill Program for Infectious Diseases, Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
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Kwan A, Daniels B, Bergkvist S, Das V, Pai M, Das J. Use of standardised patients for healthcare quality research in low- and middle-income countries. BMJ Glob Health 2019; 4:e001669. [PMID: 31565413 PMCID: PMC6747906 DOI: 10.1136/bmjgh-2019-001669] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/28/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
The use of standardised patients (SPs)-people recruited from the local community to present the same case to multiple providers in a blinded fashion-is increasingly used to measure the quality of care in low-income and middle-income countries. Encouraged by the growing interest in the SP method, and based on our experience of conducting SP studies, we present a conceptual framework for research designs and surveys that use this methodology. We accompany the conceptual framework with specific examples, drawn from our experience with SP studies in low-income and middle-income contexts, including China, India, Kenya and South Africa, to highlight the versatility of the method and illustrate the ongoing challenges. A toolkit and manual for implementing SP studies is included as a companion piece in the online supplement.
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Affiliation(s)
- Ada Kwan
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Benjamin Daniels
- McCourt School of Public Policy and School of Foreign Service, Georgetown University, Washington, District of Columbia, USA
| | - Sofi Bergkvist
- ACCESS Health International, New York City, New York, USA
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Madhukar Pai
- Department of Epidemiology & Biostatistics, and McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Jishnu Das
- McCourt School of Public Policy and School of Foreign Service, Georgetown University, Washington, District of Columbia, USA
- Center for Policy Research, Delhi, India
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