Strengthening the Bolivian pharmacovigilance system: New surveillance strategies to improve care for Chagas disease and tuberculosis

Strategies and interventions to strengthen pharmacovigilance systems in low-income and middle-income countries: a scoping review

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.

Results and evaluation of the expansion of a model of comprehensive care for Chagas disease within the National Health System: The Bolivian Chagas network

Background

Most people with chronic Chagas disease do not receive specific care and therefore are undiagnosed and do not receive accurate treatment. This manuscript discusses and evaluates a collaborative strategy to improve access to healthcare for patients with Chagas in Bolivia, a country with the highest prevalence of Chagas in the world.

Methods

With the aim of reinforcing the Chagas National Programme, the Bolivian Chagas Platform was born in 2009. The first stage of the project was to implement a vertical pilot program in order to introduce and consolidate a consensual protocol-based healthcare, working in seven centers (Chagas Platform Centers). From 2015 on the model was extended to 52 primary healthcare centers, through decentralized, horizontal scaling-up. To evaluate the strategy, we have used the WHO ExpandNet program.

Results

The strategy has significantly increased the number of patients cared for, with 181,397 people at risk of having T. cruzi infection tested and 57,871 (31·9%) new diagnostics performed. In those with treatment criteria, 79·2% completed the treatment. The program has also trained a significant number of health personnel through the specific Chagas guidelines (67% of healthcare workers in the intervention area).

Conclusions

After being recognized by the Chagas National Programme as a healthcare model aligned with national laws and priorities, the Bolivian platform of Chagas as an innovation, includes attributes that they have made it possible to expand the strategy at the national level and could also be adapted in other countries.

The Bolivian Chagas Platform was born in 2009 to promote comprehensive care for Chagas disease (CD), a neglected tropical disease that affects more than a million people in Bolivia. A two-phase strategy was designed to introduce protocol-based healthcare in Bolivia through prevention, case-management, healthcare professionals training, and community activities. From an initial seven centers in the vertical phase (Chagas Platform centers), 52 healthcare primary healthcare centers adopted CD protocolized care in a second phase (Chagas Healthcare Network) through decentralized, horizontal scaling-up. 181,397 people at risk of having T. cruzi infection were tested (15%), 57,871 (31.9%) tested positive, and 18,582 (32.1%) were treated. Sixty-seven percent of healthcare workers were trained. Adequate domestic financial and human resources were ensured at the end of the scaling-up. Translational research and training activities improved evidence-based decision-making in clinical management. The Bolivian Chagas Platform as innovation, included attributes that enabled scaling-up at national and international level.