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Choo SM, Sartori D, Lee SC, Yang HC, Syed-Abdul S. Data-Driven Identification of Factors That Influence the Quality of Adverse Event Reports: 15-Year Interpretable Machine Learning and Time-Series Analyses of VigiBase and QUEST. JMIR Med Inform 2024; 12:e49643. [PMID: 38568722 PMCID: PMC11024759 DOI: 10.2196/49643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/10/2023] [Accepted: 02/24/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The completeness of adverse event (AE) reports, crucial for assessing putative causal relationships, is measured using the vigiGrade completeness score in VigiBase, the World Health Organization global database of reported potential AEs. Malaysian reports have surpassed the global average score (approximately 0.44), achieving a 5-year average of 0.79 (SD 0.23) as of 2019 and approaching the benchmark for well-documented reports (0.80). However, the contributing factors to this relatively high report completeness score remain unexplored. OBJECTIVE This study aims to explore the main drivers influencing the completeness of Malaysian AE reports in VigiBase over a 15-year period using vigiGrade. A secondary objective was to understand the strategic measures taken by the Malaysian authorities leading to enhanced report completeness across different time frames. METHODS We analyzed 132,738 Malaysian reports (2005-2019) recorded in VigiBase up to February 2021 split into historical International Drug Information System (INTDIS; n=63,943, 48.17% in 2005-2016) and newer E2B (n=68,795, 51.83% in 2015-2019) format subsets. For machine learning analyses, we performed a 2-stage feature selection followed by a random forest classifier to identify the top features predicting well-documented reports. We subsequently applied tree Shapley additive explanations to examine the magnitude, prevalence, and direction of feature effects. In addition, we conducted time-series analyses to evaluate chronological trends and potential influences of key interventions on reporting quality. RESULTS Among the analyzed reports, 42.84% (56,877/132,738) were well documented, with an increase of 65.37% (53,929/82,497) since 2015. Over two-thirds (46,186/68,795, 67.14%) of the Malaysian E2B reports were well documented compared to INTDIS reports at 16.72% (10,691/63,943). For INTDIS reports, higher pharmacovigilance center staffing was the primary feature positively associated with being well documented. In recent E2B reports, the top positive features included reaction abated upon drug dechallenge, reaction onset or drug use duration of <1 week, dosing interval of <1 day, reports from public specialist hospitals, reports by pharmacists, and reaction duration between 1 and 6 days. In contrast, reports from product registration holders and other health care professionals and reactions involving product substitution issues negatively affected the quality of E2B reports. Multifaceted strategies and interventions comprising policy changes, continuity of education, and human resource development laid the groundwork for AE reporting in Malaysia, whereas advancements in technological infrastructure, pharmacovigilance databases, and reporting tools concurred with increases in both the quantity and quality of AE reports. CONCLUSIONS Through interpretable machine learning and time-series analyses, this study identified key features that positively or negatively influence the completeness of Malaysian AE reports and unveiled how Malaysia has developed its pharmacovigilance capacity via multifaceted strategies and interventions. These findings will guide future work in enhancing pharmacovigilance and public health.
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Affiliation(s)
- Sim Mei Choo
- Centre of Compliance & Quality Control, National Pharmaceutical Regulatory Agency, Petaling Jaya, Malaysia
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | | | - Sing Chet Lee
- Centre of Compliance & Quality Control, National Pharmaceutical Regulatory Agency, Petaling Jaya, Malaysia
| | - Hsuan-Chia Yang
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
- School of Gerontology and Long-Term Care, Taipei Medical University, Taipei, Taiwan
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Masuka JT. An Exploratory Bibliometric Analysis of African Pharmacovigilance Research Output Using SCOPUS. Cureus 2024; 16:e56295. [PMID: 38629007 PMCID: PMC11018517 DOI: 10.7759/cureus.56295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
Most global pharmacovigilance (PV) data is derived from developed countries. However, the determinants of the differences in PV research output between developing and developed countries contributing to this discrepancy still need to be explored. The objective of the current study is to describe the publication trends and characteristics of pharmacovigilance-related research stemming out of Africa in comparison to that emanating from developed countries. A bibliometric analysis was carried out using the SCOPUS literature index for published global pharmacovigilance-related articles or documents pre-COVID-19. Data on annual publication trends, citations, author affiliations, and other study characteristics such as study funding were extracted and descriptively analyzed. Author co-citation and keyword co-occurrence analyses were also conducted and presented using VOSviewer software program version 1.6.15 (CWTS, Universiteit Leiden, Netherlands). During the period under review, a total of 27,516 documents were retrieved globally. Out of these, 588 (2.1 %), 9,438 (34.3 %), and 17,829 (64.8 %) were from Africa, Europe, and the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) founder member countries respectively. Annual publications have steadily increased, but at a slower rate in Africa compared to Europe. The mean annual publications and number of citations are significantly lower in Africa compared to Europe, p < 0.0001 for both parameters. The top 10 funders of African PV activities are European and American organizations. In conclusion, improved PV activity driven by international funders has been notable on the African continent. However, there is an increased need for local funding, government involvement, and legislation to improve PV activities on the African continent.
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Affiliation(s)
- Josiah T Masuka
- Dermatology, Faculty of Health Sciences, University of Zimbabwe, Harare, ZWE
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Elhawary MA, Ogar CK, Tarapués M, Caro A, Ndagije HB, Benabdallah G, Sefiani H, Rostom H. The Role of ISoP in the Advancement of Pharmacovigilance in Low-and Middle-Income Countries (LMICs). Drug Saf 2023; 46:1307-1312. [PMID: 37874450 DOI: 10.1007/s40264-023-01363-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Mohamed A Elhawary
- Egyptian Ministry of Health and Population, Central Administration for Pharmaceutical Affairs (Research Coordinator of ISoP Egypt Chapter in His Personal Capacity), Cairo, Egypt.
- International Society of Pharmacovigilance (ISoP) Egypt Chapter, Cairo, Egypt.
| | - Comfort K Ogar
- International Society of Pharmacovigilance (ISoP) Africa Chapter, Abuja, Nigeria
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (General Secretary of ISoP Africa Chapter), Utrecht, The Netherlands
| | - Mónica Tarapués
- International Society of Pharmacovigilance, ISoP Secretariat Ltd, London, UK
- International Society of Pharmacovigilance (ISoP) Latin America (LATAM) Chapter (General Secertary of ISoP), Quito, Ecuador
| | - Angela Caro
- International Society of Pharmacovigilance, ISoP Secretariat Ltd, London, UK
- Pharmacy Career Director of Pontificia, Universidad Javeriana (President of ISoP), Bogotá, Colombia
| | - Helen Byomire Ndagije
- International Society of Pharmacovigilance (ISoP) Africa Chapter, Kampala, Uganda
- National Drug Authority, Directorate of Product Safety (President of ISoP Africa Chapter), Kampala, Uganda
| | - Ghita Benabdallah
- International Society of Pharmacovigilance (ISoP) Middle East Chapter, Rabat, Morocco
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat WHO Collaborating Centre, Rabat, Morocco
| | - Houda Sefiani
- International Society of Pharmacovigilance (ISoP) Middle East Chapter, Rabat, Morocco
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat WHO Collaborating Centre, Rabat, Morocco
| | - Hadir Rostom
- International Society of Pharmacovigilance (ISoP) Egypt Chapter, Cairo, Egypt
- Faculty of Pharmacy, MSA University (President of ISoP Egypt Chapter), 6th of October City, Giza, Egypt
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Menang O, Kuemmerle A, Maigetter K, Burri C. Strategies and interventions to strengthen pharmacovigilance systems in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e071079. [PMID: 37709326 PMCID: PMC10503375 DOI: 10.1136/bmjopen-2022-071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/27/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES The slow progress of pharmacovigilance (PV) in low-income and middle-income countries (LMIC) raises questions about core challenges on the growth of PV, and the appropriateness of strategies used so far to develop PV. Therefore, this scoping review aims to describe strategies and interventions to strengthen PV in LMIC and to propose recommendations for future investments in PV capacity building. INCLUSION CRITERIA Publications included were primary studies, articles, policy and guideline papers, describing interventions to strengthen PV in LMIC. METHODS The review was conducted following the Joanna Briggs Institute (JBI) guidelines on conducting scoping reviews. Literature searches were performed in MEDLINE, EMBASE, Web of Science, PDQ-evidence, CINAHL and other relevant websites from January 1990 to January 2021. Two reviewers independently screened titles, abstracts and full texts. One reviewer performed data extraction and descriptive analysis, which were reviewed by two other reviewers. RESULTS 10 922 unique titles were screened and 152 were eligible for full text review. Of these, 57 and an additional 13 reports from grey literature fulfilled eligibility criteria for inclusion in the review. These were grouped into two categories: (1) Interventions aimed at increasing PV knowledge and adverse drug reactions (ADR) reporting (45 papers), primarily education of healthcare professionals (HCP), alone or in combination with other interventions such as mobile and electronic reporting and (2) Interventions aimed at strengthening various components of the national PV system (25 papers), describing strategies or mixed interventions implemented at the national level, targeting different components of the national PV system. CONCLUSIONS Results of this review suggest that educating HCP on ADR reporting is the most common approach to build PV capacity in LMIC. Though important, education alone is insufficient and should ideally be organised within the holistic framework of strengthening national PV systems, with a focus on also building capacity for advanced activities such as signal detection.
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Affiliation(s)
- Olga Menang
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Andrea Kuemmerle
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Karen Maigetter
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Burri
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Isah AO, Opadeyi AO, Tumwijukye H, Cobelens F, Smith D, Ndomondo-Sigonda M, Harmark L, Tanui P, Tiemersma E, Mmbaga BT, Mahlangu G, Ayinbuomwan SA, Soulaymani R, Pandit JM. Funding and financial sustainability of pharmacovigilance: suggested models for funding pharmacovigilance in resource-limited African countries. Ther Adv Drug Saf 2023; 14:20420986231188836. [PMID: 37529763 PMCID: PMC10387667 DOI: 10.1177/20420986231188836] [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: 04/05/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Background An important factor hindering the growth of pharmacovigilance (PV) in resource-limited settings is the lack of adequate funds to establish a functional National Pharmacovigilance System. Consequently, the crucial function of monitoring and ensuring the availability of safe medicines in these settings cannot be guaranteed considering the peculiarities of diseases and medicines used. Objectives The objective of this paper is to provide an overview as to the availability of potential sources of funds, which could be explored to ensure Medicine Safety and to proffer a potential framework likely to ensure sustainable funding of PV in Africa. Methods/processes The process of developing this framework entailed a review of PV financing in some developed economies, a landscape study of funding of PV in some African countries, an in-depth understanding of the PV system and the organisational structure and nexus between the regulatory agencies and National Pharmacovigilance Centre. Critical points for consideration included the sources of funds, revenue pool, the disbursement of funds, budgeting and expenditure profile and the legal framework. Consultative meetings, webinars and interviews with experts were carried out. Results The findings showed that most of the PV systems were mainly integrated into the regulatory agencies regarding operational and fiscal governance with few facilities being independent of the regulatory agencies. The main source of funding was from the government with significant donor funding which is ad hoc and non-sustainable. Several potential sources were identified but yet to be exploited. There were no legal provisions for PV financing. A framework likely to ensure sustainable PV financing is suggested to capture all available sources of funding, mine the potential sources providing a sizeable pool of revenue to address its activities and enabling legal framework which will engender autonomy. Furthermore, it will address the nexus between the regulatory agencies and the PV outfits, thus enabling appropriate share of resources and blockage of diversions. Conclusion In all, addressing the various elements identified in this study and providing the legal provisions which guarantees some degree of autonomy will provide a sustainable mechanism for PV funding in the resource-limited setting of Africa.
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Affiliation(s)
- Ambrose O. Isah
- Department of Clinical Pharmacology and Therapeutics, School of Medicine, College of Medical Sciences, University of Benin/University of Benin Teaching Hospital, Benin City, Edo State PMB 1154, Nigeria
| | - Abimbola O. Opadeyi
- Department of Clinical Pharmacology and Therapeutics, University of Benin/University of Benin Teaching Hospital, Benin City, Nigeria
| | - Henry Tumwijukye
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Frank Cobelens
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Diede Smith
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Margareth Ndomondo-Sigonda
- African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD), Midrand, Johannesburg, South Africa
| | - Linda Harmark
- Netherlands Pharmacovigilance Centre Lareb, Den Bosch, The Netherlands
| | - Paul Tanui
- African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD), Midrand, Johannesburg, South Africa
| | | | | | - Gugu Mahlangu
- Medicines Control Authority of Zimbabwe, Harare, Zimbabwe
| | - Stephen A. Ayinbuomwan
- Department of Clinical Pharmacology and Therapeutics, University of Benin/University of Benin Teaching Hospital, Benin City, Nigeria
| | - Rachida Soulaymani
- WHO Collaborating Centre for Strengthening Pharmacovigilance Practices, Centre
- Anti Poison et de Pharmacovigilance du Maroc, Rabat, Morocco
| | - Jayesh M. Pandit
- PV Expert, Kenya, Association of Pharmaceutical Industries (KAPI), Nairobi, Kenya
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Ndagije HB, Walusimbi D, Atuhaire J, Ampaire S. Drug safety in Africa: a review of systems and resources for pharmacovigilance. Expert Opin Drug Saf 2023; 22:891-895. [PMID: 37676033 DOI: 10.1080/14740338.2023.2251375] [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: 05/26/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Pharmacovigilance on the African continent has developed over time, with 50 of the 54 countries currently being members of the WHO Programme for international drug monitoring. However, there are still challenges, such as weak regulation, insufficient resources, and differing policies. This expert opinion provides unique insights from long-term experience overcoming some of these challenges and proposes some solutions for implementing pharmacovigilance in resource-limited settings. AREAS COVERED This was an expert opinion on the pharmacovigilance landscape in Africa with a focus on reporting, good pharmacovigilance practice inspections, resources available, and the adoption of artificial intelligence. The literature search for the review was carried out in June 2023 on selected electronic databases that included PubMed, Embase, and Web of Science to identify relevant literature published from 2017 up to date while the expert opinion is an informed position from decades of practice in the area. EXPERT OPINION/COMMENTARY African countries are at different maturity levels and pharmacovigilance competence. A few countries have outstanding pharmacovigilance systems, while the majority do not have fully functional systems. African countries may pool resources through regional blocs to implement joint pharmacovigilance activities. With advancements in technology, countries are expected to embrace artificial intelligence to ensure sustainable pharmacovigilance practices.
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Affiliation(s)
| | - David Walusimbi
- National Pharmacovigilance Centre, National Drug Authority, Kampala, Uganda
| | - Joanita Atuhaire
- National Pharmacovigilance Centre, National Drug Authority, Kampala, Uganda
| | - Sheila Ampaire
- National Pharmacovigilance Centre, National Drug Authority, Kampala, Uganda
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7
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Kiguba R, Olsson S, Waitt C. Pharmacovigilance in low- and middle-income countries: A review with particular focus on Africa. Br J Clin Pharmacol 2023; 89:491-509. [PMID: 34937122 DOI: 10.1111/bcp.15193] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 01/25/2023] Open
Abstract
Low- and middle-income countries (LMIC) face unique challenges with regard to the establishment of robust pharmacovigilance systems capable of generating data to inform healthcare policy and practice. These include the limited integration and reliability of pharmacovigilance systems across LMIC despite recent efforts to harmonize pharmacovigilance rules and regulations in several regional economic communities. There are particular challenges relating to the need to translate reporting tools into numerous local languages and the low numbers of healthcare providers relative to number of patients, with very short consultation times. Additional factors frequent in LMIC include high uptake of herbal and traditional medication, mostly by self-medication; disruptive political conflicts jeopardizing fragile systems; and little or no access to drug utilization data, which makes it difficult to reliably estimate the true risks of medicines use. Pharmacovigilance activities are hindered by the scarcity of well-trained personnel with little or no budgetary support from national governments; high turnover of pharmacovigilance staff whose training involves a substantial amount of resources; and little awareness of pharmacovigilance among healthcare workers, decision makers and consumers. Furthermore, little collaboration between public health programmes and national medicines regulatory authorities coupled with limited investment in pharmacovigilance activities, especially during mass drug administration for neglected tropical diseases and mass vaccinations, produces major challenges in establishing a culture where pharmacovigilance is systematically embedded. Very low spontaneous reporting rates with poor quality reports hinders robust signal detection analyses. This review summarises the specific challenges and areas of progress in pharmacovigilance in LMIC with special focus on the situation in Africa.
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Affiliation(s)
- Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda
| | - Sten Olsson
- Pharmacovigilance Consulting, Uppsala, Sweden
| | - Catriona Waitt
- Department of Pharmacology and Therapeutics, University of Liverpool, UK.,Infectious Diseases Institute, Makerere University College of Health Sciences, Uganda
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Al-Zubiedi SA, Younus M, Al-Khalidi S, Ekilo M, Alshammari TM. Pharmacovigilance regulatory actions by national pharmacovigilance centers in Arab countries following COVID-19 pandemic. Expert Opin Drug Saf 2023; 22:165-174. [PMID: 35915555 DOI: 10.1080/14740338.2022.2108398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pharmacovigilance (PV) activities were affected by COVID-19. Therefore, several health authorities around the world have issued guidelines and practices to ensure that PV activities are maintained and continued during the pandemic. This study aimed to assess the impact of COVID-19 on the preparedness and performance of national PV systems in 14 Arab countries. RESEARCH DESIGN AND METHODS This was a cross-sectional study that was conducted between July and October 2020. National PV centers in 18 Arab countries were invited to participate in this study. Descriptive analysis was used to summarize and present the results of this study. RESULTS Responses were obtained from 14 (77.8%) countries. Adverse events reporting was the main PV activity that was covered by PV guidelines and practices. National guidelines and practices covered other PV activities in 8 (57.14%) of the participating countries. Performance and practices of national PV centers vary considerably among participating countries during the pandemic. CONCLUSION The findings highlight the differences in preparedness and performance of different national PV centers in participating Arab countries. Improving digital infrastructure among participating countries could serve as a useful tool to minimize the impact of the pandemic on PV activities.
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Affiliation(s)
- Sameh A Al-Zubiedi
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan.,School of Pharmacy, University of Jordan Pharmacovigilance office, The University of Jordan, Amman, Jordan
| | - Manal Younus
- Iraqi Pharmacovigilance Centre, Ministry of Health, Baghdad, Iraq
| | - Sara Al-Khalidi
- Medication Safety Research Centre, King Saud University, Riyadh, Saudi Arabia
| | | | - Thamir M Alshammari
- Medication Safety Research Centre, King Saud University, Riyadh, Saudi Arabia.,College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia
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Makhene NL, Steyn H, Vorster M, Lubbe MS, Burger JR. Development of a checklist for the assessment of pharmacovigilance guidelines in Southern Africa: a document review. Ther Adv Drug Saf 2023; 14:20420986221143272. [PMID: 36713000 PMCID: PMC9880583 DOI: 10.1177/20420986221143272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/15/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction National regulatory systems in Southern Africa reflect various stages of maturity, and pharmacovigilance (PV) practices are not aligned. In the absence of guidance for formulating PV guidelines in Southern African Development Community (SADC) countries, this study aimed to create a checklist that may be used to assess the rigour of PV guidelines in this region and provide guidance for the National Medicines Regulatory Agency (NMRA) authors. Methods A document analysis was performed based on harmonised international guidelines (n = 22) that prescribed methods of PV regulation to identify themes and items to incorporate into a checklist. The contextualisation of the checklist to the African pharmaceutical environment was accomplished by referencing peer-reviewed journal articles (n = 7). The checklist was subjected to face and content validation by non-experts and PV experts. Results The document review yielded 5 themes, 18 sub-themes, and 73 items structured into the checklist. Themes encompassed PV systems, definitions, individual case safety reporting, aggregate reporting, and risk management. Under PV systems, aspects of the quality management system were outlined, that is, the legal basis for PV, a description of the marketing authorisation holder's (MAH's) PV system, archiving of data, contracting of PV tasks, and the duties of the person responsible for the MAH's PV obligations. Definitions of the key terms and major stakeholders were identified. Reporting of individual case safety reports (ICSRs) was explicated by considering the criteria for reporting, categories of reportable information, expedited reporting requirements, reporting timelines, and ICSR reporting format. Aggregate report submission during the development and post-marketing phases was addressed. Risk management encompassed signal detection, re-evaluation of the benefit-risk ratio, the safety decision-making process, risk management planning, risk minimisation and safety communication. Conclusion The developed checklist can contribute towards assisting SADC NMRAs to formulate national PV guidelines that reflect current international practice, with local context incorporated. Plain Language Summary Developing a checklist for the evaluation of medicine safety guidelines in Southern Africa Introduction: In Southern African Development Community (SADC) countries, the guidelines for medicine safety [pharmacovigilance (PV)] that marketing authorisation holders (MAHs) and healthcare professionals need to adhere to, are not aligned. We saw the need to develop a checklist that can be used to evaluate these guidelines.Methods: We studied international documents issued by the World Health Organization (WHO), the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH), the Council for International Organizations of Medical Sciences (CIOMS) and the European Medicines Agency (EMA). On the organisational websites, we obtained 22 documents and identified 73 checklist items. All the items were arranged under 5 themes and 18 sub-themes to create the checklist. We adapted the checklist to the local context by using seven journal articles addressing PV concerns in Africa. Experts checked the content and usability of the checklist.Results: The themes were PV systems, definitions, individual case safety reporting (ICSR), combined reporting and risk management. PV systems had six sub-themes: legal structure, description of the MAH's PV system, contractual agreements, information storage, the qualified person responsible for PV (QPPV) and where the QPPV is located. We included the definitions of keywords and role-players. The ICSR theme had five sub-themes, i.e. criteria for reporting, categories of reportable information, expedited reporting, reporting timelines, and reporting format. Submission of summary reports comprised an overview of the safety profile of a medicine once it is approved by regulators, as well as during clinical trials. Risk management included signal detection, re-evaluation of the benefit-risk ratio, safety decision-making process, risk management planning, risk minimisation, and safety communication. The checklist is applied by allocating yes/no scoring per item.Conclusion: The checklist may be used by regulators within SADC to assess their PV guidelines for alignment with international standards and suitability to the local environment.
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Affiliation(s)
- Nokuthula L. Makhene
- Medicine Usage in South Africa, Faculty of
Health Sciences, North-West University, Potchefstroom, South Africa
| | - Hanlie Steyn
- Medicine Usage in South Africa, Faculty of
Health Sciences, North-West University, Potchefstroom, South Africa
| | - Martine Vorster
- Medicine Usage in South Africa, Faculty of
Health Sciences, North-West University, Potchefstroom, South Africa
| | - Martie S. Lubbe
- Medicine Usage in South Africa, Faculty of
Health Sciences, North-West University, Potchefstroom, South Africa
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Abraham NA, Tesfagaber M, Tesfamariam S. Stakeholders' Perspective on the Integration of Pharmacovigilance Activities into the Eritrean Healthcare System: A Qualitative Study. Risk Manag Healthc Policy 2023; 16:747-757. [PMID: 37113312 PMCID: PMC10128073 DOI: 10.2147/rmhp.s398811] [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: 12/09/2022] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
Purpose Understanding the integration of pharmacovigilance activities in the healthcare system and identifying existing hindering factors systematically through the eyes of stakeholders has paramount importance to realize a successful integration. Thus, this study aimed to assess the perspectives of the stakeholders of the Eritrean Pharmacovigilance Center (EPC) on the integration of pharmacovigilance activities into the Eritrean healthcare system. Methods An exploratory qualitative assessment of the integration of pharmacovigilance activities into the healthcare system was conducted. Key informant interviews were conducted among the major stakeholders of the EPC via face-to-face and telephone interviews. Data were collected between October 2020 and February 2021, and analyzed through thematic framework analysis. Results A total of 11 interviews were completed. The integration of the EPC in the healthcare system was rated as good and encouraging except in the National Blood Bank, and Health Promotion. The relationship between the EPC and Public health programs was described as mutual with an eminent impact. Several facilitating factors for integration were identified namely: the unique work culture of the EPC; provision of basic and advanced training; motivating and recognizing healthcare professionals in vigilance activities; and the financial and technical support provided to the EPC from national and international stakeholders. On the other hand, the absence of concrete communication systems, inconsistencies in training and communication, the absence of data-sharing mechanisms and policies, and the absence of designated pharmacovigilance focal persons were identified as barriers to successful integration. Conclusion Integration of the EPC in the healthcare system was found to be commendable except in some areas of the healthcare system. Therefore, the EPC should work towards identifying further areas of integration, mitigate the identified limitations and at the same time sustain the integration already initiated.
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Affiliation(s)
- Natnael Araya Abraham
- University of Oxford, Nuffield Department of Medicine, Center of Tropical Medicine and Global Health, Oxford, UK
| | - Meron Tesfagaber
- Product Evaluation and Registration Unit, National Medicines and Food Administration, Asmara, Eritrea
- Correspondence: Meron Tesfagaber, Tel +291-7501923, Fax +291-1-122899, Email
| | - Sirak Tesfamariam
- Product Evaluation and Registration Unit, National Medicines and Food Administration, Asmara, Eritrea
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Stegmann JU, Jusot V, Menang O, Gardiner G, Vesce S, Volpe S, Ndalama A, Adou F, Ofori-Anyinam O, Oladehin O, Mendoza YG. Challenges and lessons learned from four years of planning and implementing pharmacovigilance enhancement in sub-Saharan Africa. BMC Public Health 2022; 22:1568. [PMID: 35978276 PMCID: PMC9383683 DOI: 10.1186/s12889-022-13867-6] [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: 08/13/2021] [Accepted: 07/25/2022] [Indexed: 11/28/2022] Open
Abstract
Pharmacovigilance (PV) systems in many countries in sub-Saharan Africa (SSA) are not fully functional. The spontaneous adverse events (AE) reporting rate in SSA is lower than in any other region of the world, and healthcare professionals (HCPs) in SSA countries have limited awareness of AE surveillance and reporting procedures. The GSK PV enhancement pilot initiative, in collaboration with PATH and national PV stakeholders, aimed to strengthen passive safety surveillance through a training and mentoring program of HCPs in healthcare facilities in three SSA countries: Malawi, Côte d’Ivoire, and Democratic Republic of Congo (DRC). Project implementation was country-driven, led by the Ministry of Health via the national PV center or department, and was adapted to each country’s needs. The implementation phase for each country was scheduled to last 18 months. At project start, low AE reporting rates reflected that awareness of PV practices was very low among HCPs in all three countries, even if a national PV center already existed. Malawi did not have a functional PV system nor a national PV center prior to the start of the initiative. After 18 months of PV training and mentoring of HCPs, passive safety surveillance was enhanced significantly as shown by the increased number of AE reports: from 22 during 2000–2016 to 228 in 18 months to 511 in 30 months in Malawi, and ~ 80% of AE reports from trained healthcare facilities in Côte d’Ivoire. In DRC, project implementation ended after 7 months because of the SARS-CoV-2 pandemic. Main challenges encountered were delayed AE report transmission (1–2 months, due mainly to remoteness of healthcare facilities and complex procedures for transmitting reports to the national PV center), delayed or no causality assessment due to lack of expertise and/or funding, negative perceptions among HCPs toward AE reporting, and difficulties in engaging public health programs with the centralized AE reporting processes. This pilot project has enabled the countries to train more HCPs, increased reporting of AEs and identified KPIs that could be flexibly replicated in each country. Country ownership and empowerment is essential to sustain these improvements and build a stronger AE reporting culture.
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Affiliation(s)
| | | | | | - Gregory Gardiner
- GSK, London, UK.,Present affiliations: European Medicines Agency, Amsterdam, The Netherlands
| | - Sabino Vesce
- GSK, Nyon, Switzerland.,Present affiliations: Novartis, Basel, Switzerland
| | | | | | - Felix Adou
- Autorité Ivoirienne de Régulation Pharmaceutique (AIRP), Abidjan, Côte d'Ivoire
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12
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Khalili M, Sharifi H, Mesgarpour B, Kheirandish M, Olsson S, Javidnikou N, Haghdoost AA. Evaluation of Pharmacovigilance System in Iran. Int J Health Policy Manag 2022; 11:990-1000. [PMID: 33590736 PMCID: PMC9808195 DOI: 10.34172/ijhpm.2020.243] [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: 05/29/2020] [Accepted: 11/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Evaluating a pharmacovigilance system helps identify its deficiencies and could facilitate measures to remedy and improve the quantity and quality of adverse drug reaction (ADR) reports and other opportunities for pharmacovigilance systems strengthening. This study aimed to evaluate the status of pharmacovigilance in Iran using the World Health Organization (WHO) pharmacovigilance indicators with the prospect of identifying the gaps and areas for improvement. METHODS This study was conducted in 2 parts. The first part included a secondary analysis of the national data obtained from the Iranian National Pharmacovigilance Center (PVC) using a structured data collection form based on WHO core pharmacovigilance indicators. In the second part, a 3-month prospective study was carried out to investigate 2 outcome indicators, ie, length of stay and costs of medicine-related hospitalization in all patients of 2 main referral hospitals in the southeast and north of Iran. RESULTS Iran has a PVC with national policy, trained staff, and a statutory budget. In 2017, the number of ADR reports was 15.0 per 100 000 population, and 262 signals were detected during the preceding 5 years. The average length of stay and costs of medicine-related hospitalization were 5 days and US$817.2 in Afzalipour hospital and 6.6 days and US$306.7 in Razi hospital, respectively. The status of pharmacovigilance in the Iranian public health programs (PHPs) is unknown, and most of the indicators could not be assessed. CONCLUSION A robust pharmacovigilance system is a pivotal part of the overall medicines regulatory system. The Iranian pharmacovigilance system has relatively the proper structural condition. Though the underreporting of ADRs, especially medicine-related deaths, is an important issue, and some indicators' status was unclear. The Iranian pharmacovigilance program requires a higher prioritization, particularly in the PHPs, a greater allocation of resources, and cross-sectoral cooperation to bolster and achieve the pharmacovigilance objectives.
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Affiliation(s)
- Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bita Mesgarpour
- National Institute for Medical Research Development, Tehran, Iran
| | - Mehrnaz Kheirandish
- Department for Assessment and Control of Prescribing and Use of Medicines and Health Products, Food and Drug Administration, Tehran, Iran
| | - Sten Olsson
- International Society of Pharmacovigilance, London, UK
- Pharmacovigilance Consulting, Uppsala, Sweden
| | | | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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13
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Loomba AP. Pharmacovigilance in emerging economies: modeling interaction among barriers. JOURNAL OF ADVANCES IN MANAGEMENT RESEARCH 2022. [DOI: 10.1108/jamr-02-2022-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe main purpose of this paper is to identify and rank various barriers to pharmacovigilance (PV) in context of emerging economies and examine their interrelationships using the interpretive structural modeling (ISM) approach. The result is a model that offers insights about how to achieve rational and safe use of medicines and ensure patient safety as realized through robust national PV systems.Design/methodology/approachThe paper develops a model to analyze the interactions among PV barriers using the ISM approach. Based on input from clinical and medical product development experts, PV barriers in emerging economies were identified and reviewed. The hierarchical interrelationships among these PV barriers were analyzed in context of their driving/dependence powers.FindingsFindings of the study identify key PV barriers—lack of resources/infrastructure, weak legislation, unfair burden of disease, lack of PV capacity, training, and enforcement authority—that drive, or strongly influence, other barriers and thwart implementation of robust national PV systems in emerging economies. Pharmaceutical industry factors were PV barriers that were identified as autonomous, implying their relative disconnection from other barriers, and patient PV practices barrier was strongly dependent on other barriers.Research limitations/implicationsThe paper offers policy- and decision-makers alike with a framework to support further research into interdependencies among key PV barriers in emerging economies. It can serve as an impetus for further research with potential to broadening the understanding of how and why PV systems may be rendered ineffective. Future studies can be planned to apply the ISM approach to study PV barriers in the context of developed economies and draw lessons and implications for policy- and decision-makers by contrasting results from these studies.Practical implicationsThis paper contributes to the understanding of the multifaceted nature of PV and its barriers. The proposed approach gives public health decision-makers a better comprehension of driver PV barriers that have most influence on others versus dependent PV barriers, which are most influenced by others. Also, knowledge, attitude and practices of patients and caregivers can also be critical PV barriers in emerging economies. This information can be instrumental for public health policymakers, government entities, and health/PV practitioners to identify the PV barriers that they should prioritize for improvement and how to manage trade-offs between these barriers.Social implicationsPV barriers in emerging economies, as compared to developed economies, are inherently different and need to be examined in their specific context. The hierarchical ISM model suggests that resources and regulation initiatives by governments in emerging economies lead to through informed/enabled pharmaceutical supply chain players and eventually drive PV-specific knowledge, attitude, and practice outcomes improvements across their populace.Originality/valueThis paper highlights the deployment of ISM approach as a health policy decision support tool in the identifying and ranking barriers to effective PV systems in emerging economies, in terms of their contextual relationships, to achieve a better understanding as to how these interrelationships can affect national PV system outcomes.
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Stevens L, Perry KE, Moide I, Kaemala F, Nankinga J, Innes AL, Mogaba I. Leveraging Experience From Active TB Drug-Safety Monitoring and Management for Monitoring Active Antiretroviral Toxicity. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00595. [PMID: 35487562 PMCID: PMC9053160 DOI: 10.9745/ghsp-d-21-00595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022]
Abstract
Systems established for active drug safety monitoring and management of drug-resistant TB should be leveraged to ensure comprehensive surveillance for active toxicity monitoring during scale-up of newer antiretroviral regimens.
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Affiliation(s)
- Lisa Stevens
- FHI 360 Asia Pacific Regional Office, Bangkok, Thailand.
| | - Kelly E Perry
- FHI 360 Asia Pacific Regional Office, Bangkok, Thailand
| | - Iakuna Moide
- FHI 360 Papua New Guinea Office, Port Moresby, Papua New Guinea
| | - Francil Kaemala
- FHI 360 Papua New Guinea Office, Port Moresby, Papua New Guinea
| | | | | | - Ignatius Mogaba
- FHI 360 Papua New Guinea Office, Port Moresby, Papua New Guinea
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15
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Sabblah GT, Seaneke SK, Kushitor M, van Hunsel F, Taxis K, Duwiejua M, van Puijenbroek E. Evaluation of pharmacovigilance systems for reporting medication errors in Africa and the role of patients using a mixed-methods approach. PLoS One 2022; 17:e0264699. [PMID: 35239736 PMCID: PMC8893697 DOI: 10.1371/journal.pone.0264699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Reviewing the epidemiological profile of medication errors (MEs) reported by African countries and the systems put in place to report such errors is crucial because reporting plays an important role in improving patient safety. The objectives of this study were to characterize the profile of spontaneously reported MEs submitted by African countries to VigiBase; the World Health Organization (WHO) global database of individual case safety reports, describe systems in place for reporting these errors, and explore the challenges and facilitators for spontaneous reporting and understand the potential role of patients. Methods In the present study, we used, a mixed-methods sequential explanatory design involving a quantitative review of ME reports over a 21-year period (1997–2018) and qualitative interviews with employees from African countries that are members of the WHO Program for International Drug Monitoring (WHO PIDM). Descriptive statistics were used to summarize key variables of interest. Results A total of 4,205 ME reports were submitted by African countries to VigiBase representing 0.4% of all reports in the database. Only 15 countries out of the 37 WHO PIDM members from Africa contributed ME to reports, with 99% (3,874) of them reports originating from Egypt, Morocco, and South Africa. The reasons given for low reporting of MEs were weak healthcare and pharmacovigilance systems, lack of staff capacity at the national centers, illiteracy, language difficulties, and socio-cultural and religious beliefs. Some facilitators suggested by the participants to promote reporting included proactive engagement of patients regarding issues relating to MEs, leveraging on increased technology, benchmarking and mentoring by more experienced national centers. Sixteen of the twenty countries interviewed had systems for reporting MEs integrated into adverse drug reaction reporting with minimal patient involvement in seven of these countries. Patients were not involved in directly reporting MEs in the remaining 13 countries. Conclusions MEs are rarely reported through pharmacovigilance systems in African countries with limited patient involvement. The systems are influenced by multifactorial issues some of which are not directly related to healthcare.
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Affiliation(s)
- George Tsey Sabblah
- Food and Drugs Authority, Accra, Ghana
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | | | - Mawuli Kushitor
- The Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Florence van Hunsel
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, The Netherlands
| | - Katja Taxis
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Mahama Duwiejua
- School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Eugène van Puijenbroek
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, The Netherlands
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16
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Abdulrasool Z. The Development of a Pharmacovigilance System in Bahrain. Saudi Pharm J 2022; 30:825-841. [PMID: 35812145 PMCID: PMC9257873 DOI: 10.1016/j.jsps.2022.03.009] [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: 11/28/2021] [Accepted: 03/10/2022] [Indexed: 10/31/2022] Open
Abstract
Introduction Aim Objectives Methodology Results
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17
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Strengths and Weaknesses of the Pharmacovigilance Systems in Three Arab Countries: A Mixed-Methods Study Using the WHO Pharmacovigilance Indicators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052518. [PMID: 35270208 PMCID: PMC8909061 DOI: 10.3390/ijerph19052518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 12/04/2022]
Abstract
Using the WHO pharmacovigilance (PV) indicators as a framework, this study aimed to explore the structures, processes, and outcomes of three Arab countries' (Jordan, Oman, and Kuwait) PV systems to inform recommendations for countries with nascent PV systems. A mixed-methods design involving document review, semi-structured interviews, and a questionnaire was employed. Fifty-six key informants from the three countries' national PV centres (NPVCs) and pharmaceutical industry were interviewed. The questionnaire collecting quantitative measures was only completed by Oman and Kuwait's NPVCs. Using the framework, system strengths were attributed to the presence of "core" structural indicators, including a dedicated and officially recognised NPVC, PV legislation, and a national PV advisory committee, as well as "complementary" structural indicators, e.g., a computerised case-report management system. Contrastingly, weaknesses were attributed to the absence of these indicators plus other "core" structural indicators, namely, regular financial provision and adequate staff. Other weaknesses were attributed to low performance in "core" process and outcome indicators including reporting rates, reporter awareness, and signal detection. Greater governmental prioritisation through the provision of legislative enforcements, resources, and expertise as part of a well-structured system is required. More regional coordination efforts are needed to allow for sharing of expertise in order to bolster nascent systems.
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18
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Zakumumpa H, Kitutu FE, Ndagije HB, Diana NK, Ssanyu JN, Kiguba R. Provider perspectives on the acceptability and tolerability of dolutegravir-based anti-retroviral therapy after national roll-out in Uganda: a qualitative study. BMC Infect Dis 2021; 21:1222. [PMID: 34876050 PMCID: PMC8650263 DOI: 10.1186/s12879-021-06933-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The World Health Organization recommends dolutegravir (DTG) as the for first-line and second-line antiretroviral therapy (ART) worldwide. However, little is known about the acceptability and tolerability of DTG-based ART at routine points-of-care in Uganda. We set out to explore the perceptions of clinicians in ART clinics regarding the acceptability and tolerability of DTG-based ART since national roll-out in March 2018 in Uganda. METHODS We adopted a qualitative exploratory design involving 49 participants. Between September 2020 and February 2021, we conducted 22 in-depth interviews with clinicians in the ART clinics of 12 purposively selected health facilities across Uganda. The selection of study sites ensured diversity in facility ownership-type (public/private), level of service delivery (tertiary/secondary/primary) and the four major geographic sub-regions of Uganda. We conducted three focus group discussions with 27 clinicians in the participating facilities. Data were analyzed by thematic approach. RESULTS Clinicians in ART clinics acknowledged that DTG-based ART is well tolerated by the majority of their patients who appreciate the reduced pill burden, perceived less side effects and superior viral load suppression. However, they reported that a number of their patients experience adverse drug reactions (ADRs) after being transitioned to DTG. Hyperglycemia is, by far, the most commonly reported suspected ADR associated with DTG-based regimens and was cited in all but two participating facilities. Insomnia, weight gain and reduced libido are among the other frequently cited suspected ADRs. In addition, clinicians in ART clinics perceived some of the suspected ADRs as resulting from drug interactions between dolutegravir and isoniazid. Weak diagnostic capacities and shortage of associated commodities (e.g. glucometers and test kits) were reported as impediments to understanding the full extent of ADRs associated DTG-based ART. CONCLUSION While DTG-based regimens were perceived by clinicians in ART clinics to be well tolerated by the majority of their patients, they also reported that a number of patients experience suspected ADRs key among which were hyperglycemia, insomnia and reduced libido. Based on the perspectives of clinicians, we recommend that future studies examine the prevalence of dolutegravir-induced hyperglycemia in patients in Uganda.
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Affiliation(s)
- Henry Zakumumpa
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Freddy Eric Kitutu
- Sustainable Pharmaceutical Systems (SPS) Unit, Pharmacy Department, School of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Jacquellyn Nambi Ssanyu
- Sustainable Pharmaceutical Systems (SPS) Unit, Pharmacy Department, School of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
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19
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Tiemersma EW, Ali I, Alemu A, Avong YK, Duga A, Elagbaje C, Isah A, Kay A, Mmbaga BT, Mmari E, Mwamwitwa K, Nhlabatsi S, Sintayehu K, Arefayne A, Teferi M, Cobelens F, Härmark L. Baseline assessment of pharmacovigilance activities in four sub-Saharan African countries: a perspective on tuberculosis. BMC Health Serv Res 2021; 21:1062. [PMID: 34625085 PMCID: PMC8499544 DOI: 10.1186/s12913-021-07043-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background New medicines have become available for the treatment of drug-resistant tuberculosis (DR-TB) and are introduced in sub-Saharan Africa (SSA) by the national TB programs (NTPs) through special access schemes. Pharmacovigilance is typically the task of national medicines regulatory agencies (NMRAs), but the active drug safety monitoring and management (aDSM) recommended for the new TB medicines and regimens was introduced through the NTPs. We assessed the strengths and challenges of pharmacovigilance systems in Eswatini, Ethiopia, Nigeria and Tanzania, focusing on their capacity to monitor safety of medicines registered and not registered by the NMRAs for the treatment of DR-TB. Methods Assessment visits were conducted to all four countries by a multidisciplinary team. We used a pharmacovigilance indicator tool derived from existing tools, interviewed key stakeholders, and visited health facilities where DR-TB patients were treated with new medicines. Assessment results were verified with the local NMRAs and NTPs. Results Most countries have enabling laws, regulations and guidelines for the conduct of pharmacovigilance by the NMRAs. The relative success of NTP-NMRA collaboration is much influenced by interpersonal relationships between staff. Division of roles and responsibilities is not always clear and leads to duplication and unfulfilled tasks (e.g. causality assessment). The introduction of aDSM has increased awareness among DR-TB healthcare providers. Conclusion aDSM has created awareness about the importance of pharmacovigilance among NTPs. In the future, a push for conducting pharmacovigilance through public health programs seems useful, but this needs to coincide with increased collaboration with between public health programs and NMRAs with clear formulation of roles and responsibilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07043-6.
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Affiliation(s)
- Everdina W Tiemersma
- Technical Division, KNCV Tuberculosis Foundation, PO Box 146, 2501 CC, Den Haag, The Netherlands
| | - Ibrahim Ali
- National Pharmacovigilance Centre, Pharmacovigilance/Post Marketing Surveillance Directorate, National Agency for Food and Drug Administration and Control, Abuja, Nigeria
| | | | - Yohanna Kambai Avong
- Institute of Human Virology Nigeria, Federal Capital Territory, Abudja, Nigeria.,University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alemayehu Duga
- Children's Foundation, Baylor College of Medicine, Mbabane, Eswatini.,National Pharmacovigilance Center, Ministry of Health, Matsapha, Eswatini
| | | | - Ambrose Isah
- Department of Clinical Pharmacology and Therapeutics, School of Medicine, College of Medical Sciences, University of Benin, Benin, Nigeria
| | - Alexander Kay
- Department of Pediatrics, Baylor College of Medicine, Houston, USA.,Baylor Children's Foundation-Eswatini, Mbabane, Eswatini
| | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elice Mmari
- KNCV Tuberculosis Foundation, Dar es Salaam, Tanzania
| | - Kissa Mwamwitwa
- Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
| | | | | | | | - Mekonnen Teferi
- Clinical Trials Unit, Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, AHTC, Tower C4, Paasheuvelweg 25, 1105 BP, Amsterdam, The Netherlands.
| | - Linda Härmark
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
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20
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Nyirenda T, Bockarie M, Machingaidze S, Nderu M, Singh M, Fakier N, Habarugira JM, Beattie P, Pandya L, Jajkowicz D, Yazdanpanah Y, Hankins C, Makanga M. Strengthening capacity for clinical research in sub-Saharan Africa: partnerships and networks. Int J Infect Dis 2021; 110:54-61. [PMID: 34216733 DOI: 10.1016/j.ijid.2021.06.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/19/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022] Open
Abstract
Global research collaboration, through partnerships and networks, is an effective way to deliver highly impactful and sustainable research that is collectively owned and promoted for the global good. Many models exist for effective North-South collaborations that are built on trust and balanced benefits. The European & Developing Countries Clinical Trials Partnership (EDCTP) model emphasises capacity development in clinical trials and product-focused implementation research. To ensure effectiveness and sustainability, capacity development requires a long-term perspective, an integrated system-wide approach, and local ownership and leadership from countries experiencing high disease burdens. Guided by these principles, the EDCTP2 programme, established in 2014, has developed and strengthened human capital and institutional capacities in 39 countries in sub-Saharan Africa to undertake high-quality clinical research guided by good clinical and regulatory practices. Projects in these countries have involved 238 African and 163 European institutions. To date, EDCTP has supported 171 Fellows and 232 postgraduate trainees. EDCTP-short-term training activities have equipped 9628 researchers and medical personnel. The EDCTP capacity-building described here includes its Regional Networks of Excellence and its Consortia for public health emergencies which provide the foundation for sustained efforts against emerging and re-emerging global health threats.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Catherine Hankins
- Amsterdam University Institute of Global Health, Amsterdam, Netherlands
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21
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Barry A, Olsson S, Khaemba C, Kabatende J, Dires T, Fimbo A, Minzi O, Bienvenu E, Makonnen E, Kamuhabwa A, Oluka M, Guantai A, van Puijenbroek E, Bergman U, Nkayamba A, Mugisha M, Gurumurthy P, Aklillu E. Comparative Assessment of the Pharmacovigilance Systems within the Neglected Tropical Diseases Programs in East Africa-Ethiopia, Kenya, Rwanda, and Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041941. [PMID: 33671293 PMCID: PMC7922898 DOI: 10.3390/ijerph18041941] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022]
Abstract
Monitoring the safety of medicines used in public health programs (PHPs), including the neglected tropical diseases (NTD) program, is a WHO recommendation, and requires a well-established and robust pharmacovigilance system. The objective of this study was to assess the pharmacovigilance systems within the NTD programs in Ethiopia, Kenya, Rwanda, and Tanzania. The East African Community Harmonized Pharmacovigilance Indicators tool for PHPs was used to interview the staff of the national NTD programs. Data on four components, (i) systems, structures, and stakeholder coordination; (ii) data management and signal generation; (iii) risk assessment and evaluation; and (iv) risk management and communication, were collected and analyzed. The NTD programs in the four countries had a strategic master plan, with pharmacovigilance components and mechanisms to disseminate pharmacovigilance information. However, zero individual case safety reports were received in the last 12 months (2017/2018). There was either limited or no collaboration between the NTD programs and their respective national pharmacovigilance centers. None of the NTD programs had a specific budget for pharmacovigilance. The NTD program in all four countries had some safety monitoring elements. However, key elements, such as the reporting of adverse events, collaboration with national pharmacovigilance centers, and budget for pharmacovigilance activity, were limited/missing.
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Affiliation(s)
- Abbie Barry
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden; (A.B.); (S.O.); (U.B.)
| | - Sten Olsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden; (A.B.); (S.O.); (U.B.)
| | - Christabel Khaemba
- Pharmacy and Poisons Board, Kenya Lenana Road, P.O. Box 27663-00506 Nairobi, Kenya;
| | - Joseph Kabatende
- Rwanda Food and Drugs Authority, Nyarutarama Plaza, KG 9 Avenue Kigali, Rwanda;
| | - Tigist Dires
- Ethiopian Food and Drug Authority, Africa Avenue, Kirkos Sub City, P.O. Box 5681 Addis Ababa, Ethiopia;
| | - Adam Fimbo
- Tanzania Medicines and Medical Devices Authority, Off Mandela Road, Mabibo, P.O. Box 77150 Dar Es Salaam, Tanzania; (A.F.); (A.N.)
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. Box 65013 Dar es Salaam, Tanzania; (O.M.); (A.K.)
| | - Emile Bienvenu
- College of Medicine and Health Sciences, University of Rwanda, KK 737 Kigali, Rwanda; (E.B.); (M.M.)
| | - Eyasu Makonnen
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia;
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia
| | - Appolinary Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. Box 65013 Dar es Salaam, Tanzania; (O.M.); (A.K.)
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, P.O. Box 19676-00202 Nairobi, Kenya; (M.O.); (A.G.)
| | - Anastasia Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, P.O. Box 19676-00202 Nairobi, Kenya; (M.O.); (A.G.)
| | | | - Ulf Bergman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden; (A.B.); (S.O.); (U.B.)
| | - Alex Nkayamba
- Tanzania Medicines and Medical Devices Authority, Off Mandela Road, Mabibo, P.O. Box 77150 Dar Es Salaam, Tanzania; (A.F.); (A.N.)
| | - Michael Mugisha
- College of Medicine and Health Sciences, University of Rwanda, KK 737 Kigali, Rwanda; (E.B.); (M.M.)
| | - Parthasarathi Gurumurthy
- Pharmacovigilance and Clinical Trials, Botswana Medicines Regulatory Authority, P.O. Box 505155 Gaborone, Botswana;
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden; (A.B.); (S.O.); (U.B.)
- Correspondence: ; Tel.: +46-735116131
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Masuka JT, Khoza S. An analysis of the trends, characteristics, scope, and performance of the Zimbabwean pharmacovigilance reporting scheme. Pharmacol Res Perspect 2020; 8:e00657. [PMID: 32930524 PMCID: PMC7507368 DOI: 10.1002/prp2.657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022] Open
Abstract
We aimed to determine the reporting trends and characteristics of Individual Case Safety Reports (ICSRs) from the Zimbabwean national pharmacovigilance system. ICSRs submitted to VigiBaseTM, the World Health Organisation's ICSR database between January 1993 and December 2017 were retrospectively reviewed with respect to the suspected medicine, System Organ Class (SOC), adverse drug reaction (ADR) type and seriousness, Anatomic Therapeutic Chemical (ATC) group, age, and gender. In total, 4071 ICSRs were submitted to VigiBaseTM from targeted spontaneous reporting (n = 2909; 71.5%), vaccine surveillance (n = 679; 16.7%), and passive spontaneous reporting (n = 483; 11.9%), respectively. The median age, ICSR completeness score and timeliness of reporting were 34.0 years (IQR: 14.0; 43.0), 0.90 (IQR: 0.70; 1.00), and 548.0 days (IQR: 266:1131), respectively. More than half of the ICRS were from female patients (n = 2233; 54.9%). Antiretrovirals, antibiotics, vaccines, and anti‐tubercular medicines were reported in 62.9%, 27.9%, 16.7%, and 13.3% of submitted ICSRs, respectively. The most frequent ADRs involved the skin and subcutaneous systems (n = 1111; 20.5%), nervous system (n = 733; 13.5%), and gastrointestinal disorders system (n = 654; 12.1%). The number of ADRs reported for each patient was significantly related to the reported medicine's ATC category (P = .001. The number of ADRs was significantly related to the use of antiretroviral agents. In conclusion, Zimbabwe has made significant progress in establishing a functional pharmacovigilance system. However, the present system reports on a limited therapeutic spectrum of medicines and potentially underestimates the national ADR burden. Further work is required to strengthen the more sustainable spontaneous reporting system which potentially captures a variety of therapeutic classes.
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Affiliation(s)
- Josiah Tatenda Masuka
- Harare Central Hospital, Southerton, Harare, Zimbabwe.,Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella, Durban, South Africa
| | - Star Khoza
- Discipline of Pharmacology and Clinical Pharmacy, School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
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Effective integration of pharmacovigilance systems at public health facilities in resource-limited settings: A qualitative study. Res Social Adm Pharm 2019; 16:1111-1116. [PMID: 31812500 DOI: 10.1016/j.sapharm.2019.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pharmacovigilance systems increase access to safe medicines and healthcare, but their integration in public healthcare remains a challenge in many countries. The main barriers to pharmacovigilance integration are attributed to high patient load and limited capacities. OBJECTIVE To explore the challenges associated with the effective integration of pharmacovigilance systems in public healthcare in a developing country such as Namibia. METHODS A nationwide qualitative assessment of integration of pharmacovigilance systems particularly spontaneous adverse drug reaction (ADR) reporting at public health facility level was conducted. Key informant interviews were conducted among pivotal healthcare professionals involved in pharmacovigilance. The main outcomes were themes on challenges and strategies for effective integration of PV services at the facility level. Qualitative data were collected over a one-month period (i.e., March 2019), and thematically analysed. RESULTS Eight (8) key informants were recruited; the majority were pharmacists (n = 7) and male (n = 5). The main challenges affecting the effective integration of pharmacovigilance systems reporting at public health facilities were "weak pharmacovigilance policies and structures", "negative attitude of healthcare workers towards pharmacovigilance", and "limited capacity and support for implementation of pharmacovigilance activities". The main strategies for effective integration of PV systems at facilities included local capacity-building through continuing profession education and support, advocacy, stakeholder engagement, facility/region based pharmacovigilance champions, and facility-based policies for universal and inclusive reporting, (i.e. patients and health workers at all levels) as well as development of workable standard operational procedures. CONCLUSIONS The pharmacovigilance systems at healthcare facilities in Namibia were observed to have sub-optimal policies, structures and support systems, and lack health care worker buy-in. There is a need for a policy framework to ensure effective and sustainable integration of pharmacovigilance activities at public healthcare facilities.
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Tiemersma E, van den Hof S, Dravniece G, Wares F, Molla Y, Permata Y, Lukitosari E, Quelapio M, Aung ST, Aung KM, Thuy HT, Hoa VD, Sulaimanova M, Sagyndikova S, Makhmudova M, Soliev A, Kimerling M. Integration of drug safety monitoring in tuberculosis treatment programmes: country experiences. Eur Respir Rev 2019; 28:28/153/180115. [PMID: 31604816 DOI: 10.1183/16000617.0115-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 09/09/2019] [Indexed: 11/05/2022] Open
Abstract
New drugs and shorter treatments for drug-resistant tuberculosis (DR-TB) have become available in recent years and active pharmacovigilance (PV) is recommended by the World Health Organization (WHO) at least during the early phases of implementation, with active drug safety monitoring and management (aDSM) proposed for this. We conducted a literature review of papers reporting on aDSM. Up to 18 April, 2019, results have only been published from one national aDSM programme. Because aDSM is being introduced in many low- and middle-income countries, we also report experiences in introducing it into DR-TB treatment programmes, targeting the reporting of a restricted set of adverse events (AEs) as per WHO-recommended aDSM principles for the period 2014-2017. Early beneficial effects of active PV for TB patients include increased awareness about the occurrence, detection and management of AEs during TB treatment, and the increase of spontaneous reporting in some countries. However, because PV capacity is low in most countries and collaboration between national TB programmes and national PV centres remains weak, parallel and coordinated co-development of the capacities of both TB programmes and PV centres is needed.
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Affiliation(s)
| | - Susan van den Hof
- KNCV Tuberculosis Foundation, Den Haag, the Netherlands.,Centre for Infectious Disease Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Fraser Wares
- KNCV Tuberculosis Foundation, Den Haag, the Netherlands
| | | | | | - Endang Lukitosari
- National Tuberculosis Program, Ministry of Health, Jakarta, Indonesia
| | | | - Si Thu Aung
- Dept of Public Health, Ministry of Health and Sports, Yangon, Myanmar
| | | | - Hoang Thanh Thuy
- National Tuberculosis Program, Ministry of Health, Hanoi, Vietnam
| | - Vu Dinh Hoa
- National Centre of Drug Information and Adverse Drug Reactions & Hanoi University of Pharmacy, Hanoi, Vietnam
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25
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Şardaş S, Kendirci A. Panvigilance: Integrating Biomarkers in Clinical Trials for Systems Pharmacovigilance. ACTA ACUST UNITED AC 2019; 23:134-137. [DOI: 10.1089/omi.2019.0020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Semra Şardaş
- Department of Toxicology, Faculty of Pharmacy, İstinye University, İstanbul, Turkey
| | - Aslıgül Kendirci
- Department of Toxicology, Faculty of Pharmacy, İstinye University, İstanbul, Turkey
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