Time to embrace access programmes for medicines: lessons from the South African flucytosine access programme.

Antifungal Agents / therapeutic use Flucytosine / therapeutic use Health Services Accessibility Humans Meningitis, Cryptococcal / drug therapy South Africa
5FC Access Access programme Cryptococcal Cryptococcal meningitis Flucytosine Market failure Public health

Journal

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ISSN: 1878-3511
Titre abrégé: Int J Infect Dis
Pays: Canada
ID NLM: 9610933

Informations de publication

Date de publication:
Jun 2020
Historique:
received: 24 12 2019
revised: 24 02 2020
accepted: 26 02 2020
pubmed: 4 3 2020
medline: 21 8 2020
entrez: 4 3 2020
Statut: ppublish

Résumé

Cryptococcal meningitis (CM) is estimated to cause 181 000 deaths annually, with the majority occurring in Sub-Saharan Africa. Flucytosine is recommended by the World Health Organization as part of the treatment for CM. Widespread use of flucytosine could reduce mortality in hospital by as much as 40% compared to the standard of care, yet due to market failure, quality-assured flucytosine remains unregistered and largely inaccessible throughout Africa. The recently established South African flucytosine clinical access programme is an attempt to address the market failure that led to a lack of public sector access to flucytosine for CM, by making the medicine freely available to tertiary hospitals in South Africa. Between November 2018 and September 2019, 327 CM patients received flucytosine through this programme, with efforts to support sustainable national scale-up presently ongoing. We describe why this programme was needed, its catalytic potential, what is still required to ensure widespread access to flucytosine, and observations from this experience that may have wider relevance. The South African flucytosine access programme illustrates how access programmes may be one part of the solution to addressing the vicious cycle of perceived low demand, limiting manufacturer interest in specific product markets.

Sections du résumé

BACKGROUND BACKGROUND
Cryptococcal meningitis (CM) is estimated to cause 181 000 deaths annually, with the majority occurring in Sub-Saharan Africa. Flucytosine is recommended by the World Health Organization as part of the treatment for CM. Widespread use of flucytosine could reduce mortality in hospital by as much as 40% compared to the standard of care, yet due to market failure, quality-assured flucytosine remains unregistered and largely inaccessible throughout Africa.
METHODS METHODS
The recently established South African flucytosine clinical access programme is an attempt to address the market failure that led to a lack of public sector access to flucytosine for CM, by making the medicine freely available to tertiary hospitals in South Africa.
RESULTS RESULTS
Between November 2018 and September 2019, 327 CM patients received flucytosine through this programme, with efforts to support sustainable national scale-up presently ongoing. We describe why this programme was needed, its catalytic potential, what is still required to ensure widespread access to flucytosine, and observations from this experience that may have wider relevance.
CONCLUSIONS CONCLUSIONS
The South African flucytosine access programme illustrates how access programmes may be one part of the solution to addressing the vicious cycle of perceived low demand, limiting manufacturer interest in specific product markets.

Identifiants

DOI: 10.1016/j.ijid.2020.02.057 PMID: 32126322
pubmed: 32126322
pii: S1201-9712(20)30116-8
doi: 10.1016/j.ijid.2020.02.057
pii:
doi:

Substances chimiques

Antifungal Agents 0
Flucytosine D83282DT06

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

459-461

Informations de copyright

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Auteurs

Amir Shroufi (A)

Doctors Without Borders South Africa, Johannesburg, South Africa.

Nelesh P Govender (NP)

National Institute for Communicable Diseases, A Division of the National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa.

Graeme Meintjes (G)

University of Cape Town, Western Cape, South Africa.

John Black (J)

Livingstone Hospital, Eastern Cape, South Africa.

Jeremy Nel (J)

Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Mahomed-Yunus S Moosa (MS)

University of Kwa Zulu Natal, Kwa Zulu Natal, South Africa.

Colin Menezes (C)

Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Chris Hani Baragwanath Hospital, Johannesburg, South Africa.

Halima Dawood (H)

University of Kwa Zulu Natal, Kwa Zulu Natal, South Africa.

Douglas Wilson (D)

Edendale Hospital, Kwa Zulu Natal, South Africa.

Laura Trivino Duran (LT)

Doctors Without Borders South Africa, Johannesburg, South Africa.

Olawale Ajose (O)

Drugs for Neglected Diseases Initiative, Los Angeles, USA.

Richard A Murphy (RA)

David Geffen School of Medicine at UCLA, Los Angeles, USA; The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, USA.

Thomas Harrison (T)

Centre for Global Health, Institute of Infection and Immunity, St George's University of London, London, UK; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.

Angela Loyse (A)

Department of Infection and Immunity, St George's University of London, London, UK.

Carol Ruffell (C)

Drugs for Neglected Diseases Initiative, Los Angeles, USA; Global Antibiotic Research and Development Partnership (GARDP), Cape Town, South Africa.

Gilles Van Cutsem (G)

Doctors Without Borders South Africa, Johannesburg, South Africa; Centre for Infectious Disease and Research, University of Cape Town, Cape Town, South Africa.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antifongiques › Time to embrace access programmes for...
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Pyrimidines › Pyrimidinones › Cytosine › Flucytosine › Time to embrace access programmes for...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Accessibilité des services de santé › Time to embrace access programmes for...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Time to embrace access programmes for...
questionsmedicales.fr › Maladies du système nerveux › Méningite › Méningite fongique › Méningite cryptococcique › Time to embrace access programmes for...
questionsmedicales.fr › Régions géographiques › Afrique › Afrique subsaharienne › Afrique australe › République d'Afrique du Sud › Time to embrace access programmes for...