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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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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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Mor N, Sen D, Zaheen S, Khan R, Naik P, Basu N. The pharmacy as a primary care provider. Front Public Health 2023; 11:1221439. [PMID: 37693714 PMCID: PMC10483221 DOI: 10.3389/fpubh.2023.1221439] [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: 05/12/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Primary care is an essential component of any health system, but building high-quality primary care has proven to be a challenge for most developing countries. Among the multiplicity of providers in South Asia, one of the most ubiquitous channels through which not only medicines are obtained but also primary care advice is sought is the neighborhood pharmacy. There are widespread availability of pharmacies in South Asia. There is also good evidence that working with pharmacies in this way is a globally accepted idea, and there are several examples of countries, such as France and Nigeria, that have integrated pharmacies into their primary care systems and entrusted them with significant responsibilities. Methods In this paper, we explore the potential of this channel as a formal primary care provider, with a particular focus on the South Asian context, by examining how pharmacies perform against the seven Starfield attributes of (i) first contact care, (ii) continuity of care, (iii) comprehensiveness, (iv) coordination, (v) family centredness, (vi) cultural competency, and (vii) community orientation. In the paper, we use data on pharmacies from four pharmacy-related interventions, one from Bangladesh and three from India, to carry out our analysis using the Qualitative Comparative Analysis (QCA) framework. Results We find that even in the South Asian context, pharmacies provide several components of good primary care. As expected, they demonstrate a strong orientation toward the community in which they are located and are able to provide first-contact care. However, we find no direct evidence that they are able to offer continuity of care or bring to bear family-centredness and cultural competency when dealing with their patients. It is encouraging, however, that while there is no formal evidence of this in any of the interventions, multiple anecdotal examples suggest that pharmacists do indeed do much of this, but perhaps in an informal and inconsistent manner. Discussion The evidence from these studies provides support for the view that pharmacies have many of the inherent characteristics needed to become an effective primary care channel and already play an important role in providing access to health information and care. However, it is also clear from the research that without additional training and access to tools, pharmacies will not have the competency or knowledge necessary to provide these services or even act as an effective gateway to other healthcare providers. To fully unlock this opportunity, therefore, any organization that wishes to engage with them will need to have the vision and patience to work with this network for an extended period of time and not merely aspire for incremental improvements but have a strategy in place that fundamentally changes the capabilities and the roles that pharmacies can play.
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Affiliation(s)
- Nachiket Mor
- Banyan Academy of Leadership in Mental Health, Chennai, India
| | - Dyuti Sen
- India Fellow, Independent Researcher, New Delhi, India
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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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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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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 DOI: 10.1371/journal.pgph.0001898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Needamangalam Balaji J, Prakash S, Park Y, Baek JS, Shin J, Rajaguru V, Surapaneni KM. A Scoping Review on Accentuating the Pragmatism in the Implication of Mobile Health (mHealth) Technology for Tuberculosis Management in India. J Pers Med 2022; 12:jpm12101599. [PMID: 36294738 PMCID: PMC9605544 DOI: 10.3390/jpm12101599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: India continues to share a colossal count of the global tuberculosis load, with a perturbing 19% spring in the reported cases in 2021. With the National Tuberculosis Elimination Program (NTEP) consolidated to bring this epidemic to an end by 2025, the rapidly growing mobile health technologies can be utilized to offer promising results. Even though the implementation of this novel strategy is escalating around the globe, its triumph is still sub optimal in India. Objectives: This scoping review intends to explore the available mobile health (mHealth) technologies and analyse the effectiveness of the same for tuberculosis management in India. Methods: An elaborate search in electronic databases, such as PubMed and Google scholar, using the key terms and focussing from the year 2015, provided very broad results focussing on mHealth interventions and their utilisation in TB management in India. Further selection of the inclusive publications was carried out based upon the eligibility requirements as formulated for this review, pertaining to the objective of this study. Results: The collaborate search yielded a total of 858 scientific research papers. After the filtering of the obtained results, a total of 45 articles were selected to be analysed for this review. Published manuscripts, articles in peer review and abstracts from reliable databases were included to obtain vast range of information. Conclusion: The extensive literature search showed a preponderance of mHealth intervention studies focusing on TB treatment and drug monitoring. There exists a paucity of mHealth applications targeted to educate the public and intercept this infectious disease. The scientific articles reviewed and analysed in this scoping review strongly recommend the demployment of mHealth applications to achieve the target of eradicating TB by 2025 in India.
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Affiliation(s)
- Jyotsna Needamangalam Balaji
- Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamalle, Chennai 600-123, Tamil Nadu, India
| | - Sreenidhi Prakash
- Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamalle, Chennai 600-123, Tamil Nadu, India
| | - Youngmok Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Joon Sang Baek
- Department of Human Environment and Design, Yonsei University, Seoul 03722, Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Vasuki Rajaguru
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
| | - Krishna Mohan Surapaneni
- SMAART Population Health Informatics Intervention Center, Foundation of Healthcare Technologies Society, Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Chennai 600-123, Tamil Nadu, India
- Departments of Biochemistry, Medical Education, Molecular Virology, Research, Clinical Skills & Simulation, Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Chennai 600-123, Tamil Nadu, India
- Correspondence:
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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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Shah HD, Nazli Khatib M, Syed ZQ, Gaidhane AM, Yasobant S, Narkhede K, Bhavsar P, Patel J, Sinha A, Puwar T, Saha S, Saxena D. Gaps and Interventions across the Diagnostic Care Cascade of TB Patients at the Level of Patient, Community and Health System: A Qualitative Review of the Literature. Trop Med Infect Dis 2022; 7:tropicalmed7070136. [PMID: 35878147 PMCID: PMC9315562 DOI: 10.3390/tropicalmed7070136] [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: 06/14/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis (TB) continues to be one of the important public health concerns globally, and India is among the seven countries with the largest burden of TB. There has been a consistent increase in the notifications of TB cases across the globe. However, the 2018 estimates envisage a gap of about 30% between the incident and notified cases of TB, indicating a significant number of patients who remain undiagnosed or ‘missed’. It is important to understand who is ‘missed’, find this population, and provide quality care. Given these complexities, we reviewed the diagnostic gaps in the care cascade for TB. We searched Medline via PubMed and CENTRAL databases via the Cochrane Library. The search strategy for PubMed was tailored to individual databases and was as: ((((((tuberculosis[Title/Abstract]) OR (TB[Title/Abstract])) OR (koch *[Title/Abstract])) OR (“tuberculosis”[MeSH Terms]))) AND (((diagnos *) AND (“diagnosis”[MeSH Terms])))). Furthermore, we screened the references list of the potentially relevant studies to seek additional studies. Studies retrieved from these electronic searches and relevant references included in the bibliography of those studies were reviewed. Original studies in English that assessed the causes of diagnostic gaps and interventions used to address them were included. Delays in diagnosis were found to be attributable to both the individuals’ and the health system’s capacity to diagnose and promptly commence treatment. This review provides insights into the diagnostic gaps in a cascade of care for TB and different interventions adopted in studies to close this gap. The major diagnostic gaps identified in this review are as follows: people may not have access to TB diagnostic tests, individuals are at a higher risk of missed diagnosis, services are available but people may not seek care with a diagnostic facility, and patients are not diagnosed despite reaching health facilities. Therefore, reaching the goal to End TB requires putting in place models and methods to provide prompt and quality assured diagnosis to populations at par.
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Affiliation(s)
- Harsh D Shah
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; (S.Y.); (K.N.); (P.B.); (J.P.); (A.S.); (T.P.); (S.S.); (D.S.)
- Correspondence:
| | - Mahalaqua Nazli Khatib
- Global Evidence Synthesis Initiative, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha 442004, India; (M.N.K.); (Z.Q.S.); (A.M.G.)
| | - Zahiruddin Quazi Syed
- Global Evidence Synthesis Initiative, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha 442004, India; (M.N.K.); (Z.Q.S.); (A.M.G.)
| | - Abhay M. Gaidhane
- Global Evidence Synthesis Initiative, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha 442004, India; (M.N.K.); (Z.Q.S.); (A.M.G.)
| | - Sandul Yasobant
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; (S.Y.); (K.N.); (P.B.); (J.P.); (A.S.); (T.P.); (S.S.); (D.S.)
- Global Evidence Synthesis Initiative, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha 442004, India; (M.N.K.); (Z.Q.S.); (A.M.G.)
| | - Kiran Narkhede
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; (S.Y.); (K.N.); (P.B.); (J.P.); (A.S.); (T.P.); (S.S.); (D.S.)
| | - Priya Bhavsar
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; (S.Y.); (K.N.); (P.B.); (J.P.); (A.S.); (T.P.); (S.S.); (D.S.)
| | - Jay Patel
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; (S.Y.); (K.N.); (P.B.); (J.P.); (A.S.); (T.P.); (S.S.); (D.S.)
| | - Anish Sinha
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; (S.Y.); (K.N.); (P.B.); (J.P.); (A.S.); (T.P.); (S.S.); (D.S.)
| | - Tapasvi Puwar
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; (S.Y.); (K.N.); (P.B.); (J.P.); (A.S.); (T.P.); (S.S.); (D.S.)
| | - Somen Saha
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; (S.Y.); (K.N.); (P.B.); (J.P.); (A.S.); (T.P.); (S.S.); (D.S.)
- Global Evidence Synthesis Initiative, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha 442004, India; (M.N.K.); (Z.Q.S.); (A.M.G.)
| | - Deepak Saxena
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; (S.Y.); (K.N.); (P.B.); (J.P.); (A.S.); (T.P.); (S.S.); (D.S.)
- Global Evidence Synthesis Initiative, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha 442004, India; (M.N.K.); (Z.Q.S.); (A.M.G.)
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10
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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] [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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11
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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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12
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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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13
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Tran PMT, Dam TA, Huynh HB, Codlin AJ, Forse RJ, Dang HMT, Truong VV, Nguyen LH, Nguyen HB, Nguyen NV, Creswell J, Meralli F, Morishita F, Dong TTT, Nguyen GH, Vo LNQ. Evaluating novel engagement mechanisms, yields and acceptability of tuberculosis screening at retail pharmacies in Ho Chi Minh City, Viet Nam. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000257. [PMID: 36962503 PMCID: PMC10021543 DOI: 10.1371/journal.pgph.0000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 08/28/2022] [Indexed: 03/26/2023]
Abstract
Pharmacies represent a key health system entry point for people with TB in Viet Nam, but high fragmentation hinders their broader engagement. Professional networking apps may be able to facilitate pharmacy engagement for systematic TB screening and referral. Between September and December 2019, we piloted the use of a social networking app, SwipeRx, to recruit pharmacists for a TB referral scheme across four districts of Ho Chi Minh City, Viet Nam. We measured chest X-ray (CXR) referrals and TB detection yields at participating pharmacies and fielded 100 acceptability surveys, divided into pharmacists who did and did not make a CXR referral. We then fitted mixed-effect odds proportional models to explore acceptability factors that were associated with making a CXR referral. 1,816 push notifications were sent to pharmacists via the SwipeRx app and 78 indicated their interest in participating; however, only one was within the pilot's intervention area. Additional in-person outreach resulted in the recruitment of 146 pharmacists, with 54 (37.0%) making at least one CXR referral. A total of 182 pharmacy customers were referred, resulting in a total of 64 (35.2%) CXR screens and seven people being diagnosed with TB. Compared to pharmacists who did not make any CXR referrals, pharmacists making at least one CXR referral understood the pilot's objectives more clearly (aOR = 2.6, 95% CI: 1.2-5.8) and they believed that TB screening increased customer trust (aOR = 2.7, 95% CI: 1.2-5.8), benefited their business (aOR = 2.8, 95% CI: 1.3-6.2) and constituted a competitive advantage (aOR = 4.4, 95% CI: 1.9-9.9). They were also more confident in using mHealth apps (aOR = 3.1, 95 CI%: 1.4-6.8). Pharmacies can play an important role in early and increased TB case finding. It is critical to highlight the value proposition of TB referral schemes to their business during recruitment. Digital networking platforms, such as SwipeRx, can facilitate referrals for TB screening by pharmacists, but their ability to identify and recruit pharmacists requires optimization, particularly when targeting specific segments of a nation-wide digital network.
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Affiliation(s)
| | - Thu A Dam
- Friends for International TB Relief, Ha Noi, Viet Nam
| | - Huy B Huynh
- Friends for International TB Relief, Ha Noi, Viet Nam
| | | | | | - Ha M T Dang
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | - Vinh V Truong
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | - Lan H Nguyen
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | | | | | | | | | - Fukushi Morishita
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Thuy T T Dong
- Friends for International TB Relief, Ha Noi, Viet Nam
| | | | - Luan N Q Vo
- Friends for International TB Relief, Ha Noi, Viet Nam
- IRD VN, Ho Chi Minh City, Viet Nam
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14
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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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15
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Haque M, Kumar S, Charan J, Bhatt R, Islam S, Dutta S, Abhayanand JP, Sharma Y, Sefah I, Kurdi A, Wale J, Godman B. Utilisation, Availability and Price Changes of Medicines and Protection Equipment for COVID-19 Among Selected Regions in India: Findings and Implications. Front Pharmacol 2021; 11:582154. [PMID: 33628172 PMCID: PMC7898674 DOI: 10.3389/fphar.2020.582154] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background: COVID-19 has already claimed a considerable number of lives worldwide. However, there are concerns with treatment recommendations given the extent of conflicting results with suggested treatments and misinformation, some of which has resulted in increased prices and shortages alongside increasing use and prices of personal protective equipment (PPE). This is a concern in countries such as India where there have been high patient co-payments and an appreciable number of families going into poverty when members become ill. However, balanced against pricing controls. Community pharmacists play a significant role in disease management in India, and this will remain. Consequently, there is a need to review prices and availability of pertinent medicines during the early stages of the COVID-19 pandemic in India to provide future direction. Objective: Assess current utilisation and price changes as well as shortages of pertinent medicines and equipment during the early stages of the pandemic. Our Approach: Multiple approach involving a review of treatments and ongoing activities across India to reduce the spread of the virus alongside questioning pharmacies in selected cities from early March to end May 2020. Our Activities: 111 pharmacies took part, giving a response rate of 80%. Encouragingly, no change in utilisation of antimalarial medicines in 45% of pharmacies despite endorsements and for antibiotics in 57.7% of pharmacies, helped by increasing need for a prescription for dispensing. In addition, increased purchasing of PPE (over 98%). No price increases were seen for antimalarials and antibiotics in 83.8 and 91.9% of pharmacies respectively although shortages were seen for antimalarials in 70.3% of pharmacies, lower for antibiotics (9.9% of pharmacies). However, price increases were typically seen for PPE (over 90% of stores) as well as for analgesics (over 50% of pharmacies). Shortages were also seen for PPE (88.3%). Conclusion: The pandemic has impacted on utilisation and prices of pertinent medicines and PPE in India but moderated by increased scrutiny. Key stakeholder groups can play a role with enhancing evidenced-based approaches and reducing inappropriate purchasing in the future.
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rohan Bhatt
- Department of Pediatric Dentistry, Karnavati University, Gandhinagar, India
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Bangladesh
| | - Siddhartha Dutta
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | | | - Yesh Sharma
- Department of Conservative Dentistry and Endodontics, Rajasthan University of Health Sciences, Jaipur, India
| | - Israel Sefah
- Pharmacy Department, Ghana Health Service, Keta Municipal Hospital, Keta-Dzelukope, Ghana
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, 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
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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16
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Godman B, Haque M, Islam S, Iqbal S, Urmi UL, Kamal ZM, Shuvo SA, Rahman A, Kamal M, Haque M, Jahan I, Islam MZ, Hossain MM, Munzur-E-Murshid, Kumar S, Charan J, Bhatt R, Dutta S, Abhayanand JP, Sharma Y, Saleem Z, Phuong TNT, Kwon HY, Kurdi A, Wale J, Sefah I. Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future. Front Public Health 2020; 8:585832. [PMID: 33381485 PMCID: PMC7767884 DOI: 10.3389/fpubh.2020.585832] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- 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
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Samiul Iqbal
- Department of Orthodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Umme Laila Urmi
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Zubair Mahmood Kamal
- Integrated Sleep Disorders Center, McGuire VAMC/VCU Health, Richmond, VA, United States
| | | | - Aminur Rahman
- Finance & Account Division, Grameen Euglena, Dhaka, Bangladesh
| | - Mustafa Kamal
- Al-Manar Hospital Ltd., Modern Hospital Cumilla Ltd., Dhaka, Bangladesh
| | - Monami Haque
- Human Resource Department, Square Toiletries Limited, Rupayan Center, Dhaka, Bangladesh
| | - Iffat Jahan
- Department of Physiology, Eastern Medical College, Comilla, Bangladesh
| | - Md. Zakirul Islam
- Department of Pharmacology, Eastern Medical College, Comilla, Bangladesh
| | | | - Munzur-E-Murshid
- WISH2ACTION Project, Handicap International, Kurigram, Bangladesh
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rohan Bhatt
- Department of Pediatric Dentistry, Karnavati University, Gandhinagar, India
| | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Yesh Sharma
- Department of Conservative Dentistry and Endodontics, Rajasthan University of Health Sciences, Jaipur, India
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Hye-Young Kwon
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - 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
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Israel Sefah
- Ghana Health Service, Keta Municipal Hospital, Pharmacy Department, Keta, Ghana
- University of Health and Allied Sciences, School of Pharmacy, Pharmacy Practice Department, Volta Region, Ghana
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Banu S, Haque F, Ahmed S, Sultana S, Rahman MM, Khatun R, Paul KK, Kabir S, Rahman SMM, Banu RS, Islam MS, Ross AG, Clemens JD, Stevens R, Creswell J. Social Enterprise Model (SEM) for private sector tuberculosis screening and care in Bangladesh. PLoS One 2020; 15:e0241437. [PMID: 33226990 PMCID: PMC7682881 DOI: 10.1371/journal.pone.0241437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In Bangladesh, about 80% of healthcare is provided by the private sector. Although free diagnosis and care is offered in the public sector, only half of the estimated number of people with tuberculosis are diagnosed, treated, and notified to the national program. Private sector engagement strategies often have been small scale and time limited. We evaluated a Social Enterprise Model combining external funding and income generation at three tuberculosis screening centres across the Dhaka Metropolitan Area for diagnosing and treating tuberculosis. METHODS AND FINDINGS The model established three tuberculosis screening centres across Dhaka Metropolitan Area that carried the icddr,b brand and offered free Xpert MTB/RIF tests to patients visiting the screening centres for subsidized, digital chest radiographs from April 2014 to December 2017. A network of private and public health care providers, and community recommendation was formed for patient referral. No financial incentives were offered to physicians for referrals. Revenues from radiography were used to support screening centres' operation. Tuberculosis patients could choose to receive treatment from the private or public sector. Between 2014 and 2017, 1,032 private facilities networked with 8,466 private providers were mapped within the Dhaka Metropolitan Area. 64, 031 patients with TB symptoms were referred by the private providers, public sector and community residents to the three screening centres with 80% coming from private providers. 4,270 private providers made at least one referral. Overall, 10,288 pulmonary and extra-pulmonary tuberculosis cases were detected and 7,695 were bacteriologically positive by Xpert, corresponding to 28% of the total notifications in Dhaka Metropolitan Area. CONCLUSION The model established a network of private providers who referred individuals with presumptive tuberculosis without financial incentives to icddr,b's screening centres, facilitating a quarter of total tuberculosis notifications in Dhaka Metropolitan Area. Scaling up this approach may enhance national and international tuberculosis response.
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Affiliation(s)
- Sayera Banu
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
- * E-mail:
| | - Farhana Haque
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Shahriar Ahmed
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Sonia Sultana
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Md. Mahfuzur Rahman
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Razia Khatun
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Kishor Kumar Paul
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Senjuti Kabir
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - S. M. Mazidur Rahman
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Rupali Sisir Banu
- National Tuberculosis Control Program (NTP), Ministry of Health and Welfare, Dhaka, Bangladesh
| | - Md. Shamiul Islam
- National Tuberculosis Control Program (NTP), Ministry of Health and Welfare, Dhaka, Bangladesh
| | - Allen G. Ross
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - John D. Clemens
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
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18
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Hoai Ta QT, Vo VG, Jawad M. COVID-19 and compromised tuberculosis control efforts: Highlighting the need for integration of community pharmacies into the national tuberculosis programme. Res Social Adm Pharm 2020; 17:823-825. [PMID: 33158779 PMCID: PMC7574691 DOI: 10.1016/j.sapharm.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Qui Thanh Hoai Ta
- Institute of Research and Development, Duy Tan University, Danang 550000, Vietnam.
| | - Van Giau Vo
- Bionanotechnology Research Group, Ton Duc Thang University, Ho Chi Minh City 700000, Vietnam; Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City 700000, Vietnam.
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19
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Han S, Choi S, Heo J, Park J, Kim WH. Evaluation of a Ten-Year Team-Based Collaborative Capacity-Building Program for Pediatric Cardiac Surgery in Uzbekistan: Lessons and Implications. Ann Glob Health 2020; 86:107. [PMID: 32898196 PMCID: PMC7453966 DOI: 10.5334/aogh.2883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Most children who have congenital heart disease in low- and middle-income countries (LMICs), including Uzbekistan, do not receive adequate and timely pediatric cardiac surgical care. To strengthen the surgical capacity of a local pediatric cardiac surgery team in Tashkent, Uzbekistan, the JW LEE Center for Global Medicine at Seoul National University College of Medicine has developed a team-based training program and has been collaboratively conducting surgeries and care in order to transfer on-site knowledge and skills from 2009 to 2019. Objectives To evaluate the long-term effects of the collaborative program on the cardiac surgical capacity of medical staff (teamwork, surgical complexity, and patients' pre-surgical weights) as well as changes in the lives of the patients and their families. To derive lessons and challenges for other pediatric cardiac surgical programs in LMICs. Methods To assess the effects of this ten-year long program, a mixed-methods design was developed to examine the trend of surgical complexity measured by Risk Adjustment for Congenital Heart Surgery 1 score (RACHS-1) and patients' pre-surgical weights via medical record review (surgical cases: n = 107) during the decade. Qualitative data was analyzed from in-depth interviews (n = 31) with Uzbek and Korean medical staff (n = 10; n = 4) and caregivers (n = 17). Findings During the decade, the average RACHS-1 of the cases increased from 1.9 in 2010 to 2.78 in 2019. The average weight of patients decreased by 2.8 kg from 13 kg to 10.2 kg during the decade. Qualitative findings show that the surgical capacity, as well as attitudes toward patients and colleagues of the Uzbek medical staff, improved through the effective collaboration between the Uzbek and Korean teams. Changes in the lives of patients and their families were also found following successful surgery. Conclusions Team-based training of the workforce in Uzbekistan was effective in improving the surgical skills, teamwork, and attitudes of medical staff, in addition, a positive impact on the life of patients and their families was demonstrated. It can be an effective solution to facilitate improvements in pediatric cardiovascular disease in LMICs if training is sustained over a long period.
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Affiliation(s)
- Seungheon Han
- Institute of International Affairs, Seoul National University, Seoul, KR
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, KR
| | - Sugy Choi
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, US
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, KR
| | - Jongho Heo
- National Assembly Futures Institute, Seoul, KR
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, KR
| | - Jayoung Park
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, KR
| | - Woong-Han Kim
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, KR
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, KR
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul, KR
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20
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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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Subbaraman R, Jhaveri T, Nathavitharana RR. Closing gaps in the tuberculosis care cascade: an action-oriented research agenda. J Clin Tuberc Other Mycobact Dis 2020; 19:100144. [PMID: 32072022 PMCID: PMC7015982 DOI: 10.1016/j.jctube.2020.100144] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The care cascade-which evaluates outcomes across stages of patient engagement in a health system-is an important framework for assessing quality of tuberculosis (TB) care. In recent years, there has been progress in measuring care cascades in high TB burden countries; however, there are still shortcomings in our knowledge of how to reduce poor patient outcomes. In this paper, we outline a research agenda for understanding why patients fall through the cracks in the care cascade. The pathway for evidence generation will require new systematic reviews, observational cohort studies, intervention development and testing, and continuous quality improvement initiatives embedded within national TB programs. Certain gaps, such as pretreatment loss to follow-up and post-treatment disease recurrence, should be a priority given a relative paucity of high-quality research to understand and address poor outcomes. Research on interventions to reduce death and loss to follow-up during treatment should move beyond a focus on monitoring (or observation) strategies, to address patient needs including psychosocial and nutritional support. While key research questions vary for each gap, some patient populations may experience disparities across multiple stages of care and should be a priority for research, including men, individuals with a prior treatment history, and individuals with drug-resistant TB. Closing gaps in the care cascade will require investments in a bold and innovative action-oriented research agenda.
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Affiliation(s)
- Ramnath Subbaraman
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, USA
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA
| | - Tulip Jhaveri
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA
| | - Ruvandhi R. Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
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22
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Biswas B, Kumar A, Agarwal N. Performance of revised national tuberculosis control program in Bihar: A situational analysis. J Family Med Prim Care 2020; 9:735-739. [PMID: 32318411 PMCID: PMC7113949 DOI: 10.4103/jfmpc.jfmpc_1028_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Monitoring of a program is a continuous assessment of certain key indicators of it through periodic reports. The efficiency of a health program is assessed by comparing its achievements with the expectations. Methods: The study was conducted based on the annual TB report of India for the year 2018 in order to monitor (Revised National Tuberculosis Control Program) RNTCP performance in the Bihar State and its various districts. Results: Case notification rate of various districts Bihar was far below the national average of 138 per lakh. Considering treatment initiation, the performance of various districts of Bihar were less than national figures (79.0%). In newly diagnosed TB cases, the treatment success rate of Bihar was 73%. This performance was more compared to Uttar Pradesh (66.0%) but less compared to Jharkhand (92.0%), West Bengal (88.0%), and national data (79.5%). Considering human resources, the total human resources in the states of Bihar (61.9%) and Jharkhand (58.3%) were similar. However, in Bihar, there was a vast shortage of ground-level staff [i.e. (senior treatment supervisor) STS, (senior TB lab supervisor) STLS, (public-private mix) PPM Co-ordinator, and (TB health visitor) TBHV)]. Conclusion: It was found that Bihar was one of the less performing states in RNTCP with a vast shortage of ground-level staff and low overall treatment success rate compared to its neighboring states. Stringent monitoring and evaluation in every step of the program implementation should be done in order to improve RNTCP performance in Bihar.
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Affiliation(s)
- Bijit Biswas
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Abhishek Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Neeraj Agarwal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
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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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Isaac G, Robert EJ, Swabrah N, Gloria N, Okungura PD, Oboth P, Iramiot JS, Nekaka R. Community- based Active Tuberculosis Case Finding in Pastoralist Communities of North-Eastern Uganda. ACTA ACUST UNITED AC 2019; 29:1-10. [PMID: 34169184 PMCID: PMC8221588 DOI: 10.9734/mrji/2019/v29i330166] [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] [Indexed: 11/09/2022]
Abstract
Background Given the global urgency to improve tuberculosis (TB) case detection, a renewed interest in active case finding (ACF) has risen. Missed TB cases pose a serious threat as they continue to fuel TB transmission in the community. We aimed to assess the feasibility of community based ACF for TB among people living in a pastoralist community in Uganda and determine its impact on case detection and treatment uptake. Methods Between April and May 2019, four third year medical and nursing students placed at Moroto Regional Referral for community orientation worked together with community health workers to conduct a door-to-door survey for TB in pastoralist communities of Nadunget Sub County, Moroto district. The community health workers and the Medical/Nursing students performed symptom screening, collected sputum and facilitated specimen transport to the laboratory. Gene Xpert MTB/RIF assay was performed at the regional referral Hospital for all sputum samples. The community health workers were tasked to follow up on all those clients whose samples turned out to be positive so that they could start treatment as soon as possible. All presumptive cases with negative sputum results were referred to the TB clinic for further evaluation. Results In one month, we screened 385 individuals and identified 143 aged above 15 years with symptoms suggestive of TB. Among the presumptive cases, 132 (92%) reported a cough of more than two weeks and we were able to obtain sputum samples from 84(58.7%) participants. We diagnosed 11, including 8 bacteriologically confirmed TB cases using Gene Xpert and there was no multidrug resistant case identified. The median time from sputum collection to notification of the positive result was 3 days. All the positive cases were followed up and initiated on treatment. Conclusion The findings from our study suggest that in a pastoralist community, ACF for TB using a sensitive symptom screen followed by Gene Xpert contributed to improved case detection of TB, shortening the turnaround time hence timely initiation of patients on TB treatment.
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Affiliation(s)
- Guma Isaac
- Department of community and public Health, Faculty of Health Sciences Busitema University, Uganda
| | - Emuron John Robert
- Department of community and public Health, Faculty of Health Sciences Busitema University, Uganda
| | - Namugambe Swabrah
- Department of community and public Health, Faculty of Health Sciences Busitema University, Uganda
| | - Nabirye Gloria
- Department of community and public Health, Faculty of Health Sciences Busitema University, Uganda
| | | | - Paul Oboth
- Department of community and public Health, Faculty of Health Sciences Busitema University, Uganda
| | - Jacob S Iramiot
- Department of Microbiology and Immunology, Faculty of Health Sciences Busitema University, Uganda
| | - Rebecca Nekaka
- Department of community and public Health, Faculty of Health Sciences Busitema University, Uganda
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McDowell A, Engel N, Daftary A. In the eye of the multiple beholders: Qualitative research perspectives on studying and encouraging quality of TB care in India. J Clin Tuberc Other Mycobact Dis 2019; 16:100111. [PMID: 31497654 PMCID: PMC6716552 DOI: 10.1016/j.jctube.2019.100111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This paper outlines insights qualitative research brings to the study of quality of care. It advocates understanding care as sequential, interpersonal action aimed at improving health and documenting the networks in which care occurs. It assesses the strengths and weakness of contemporary quantitative and qualitative approaches to examining quality of care for tuberculosis (TB) before outlining three qualitative research programs aimed at understanding quality of TB in India. Three case studies focus on the diagnosis level in the cascade of TB care and use qualitative research to examine the clinical use of pharmaceuticals as diagnostics, the development of diagnostic tests, and the role of care providers in the utilization of diagnostic services. They show that 1) care must be understood as part of relationships over time, 2) the presence or absence of technologies does not always imply their expected use in care, 3) physicians' provision of care is often inflected by their perceptions of patient desires, and 4) effective care is not always perfectly aligned with global health priorities. Qualitative methods with a networked perspective on care provide novel findings that can and have been used when developing quality of care improvement interventions for TB.
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Affiliation(s)
- Andrew McDowell
- Department of Anthropology, Tulane University, New Orleans, USA
- CERMES3, Institute National de la Santé et la Recherché Médicale, Paris, France
| | - Nora Engel
- Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Amrita Daftary
- McGill International TB Centre and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Centre for the AIDS Programme of Research (CAPRISA), University of KwaZulu Natal, Durban, South Africa
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