A pharmacy too far? Equity and spatial distribution of outcomes in the delivery of subsidized artemisinin-based combination therapies through private drug shops
A pharmacy too far? Equity and spatial distribution of outcomes in the delivery of subsidized artemisinin-based combination therapies through private drug shops
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DOI：
10.1186/1472-6963-10-s1-s6
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发表时间：
2010-07-02
影响因子：
2.8
通讯作者：
Goodman, Catherine
中科院分区：
文献类型：
--
作者：
Cohen, Justin M.;Sabot, Oliver;Goodman, Catherine
背景：数百万患有疟疾样发烧的人从私人零售商购买药物，但由于费用相对较高，以青蒿素为基础的联合疗法（ACTs）很少通过这些渠道获得，而青蒿素联合疗法是对旧药耐药性高的地区唯一有效的治疗方法。为了鼓励扩大以青蒿素为基础的联合治疗，正在启动可负担药物基金——疟疾，以补贴其价格。坦桑尼亚政府和克林顿基金会在坦桑尼亚的两个地区试行了这种补贴发放模式，以审查人们对干预措施能否成功地覆盖贫困农村社区的担忧。方法：在基线和随后15个月的4次调查中，对所有零售商店的ACTs和其他抗疟疾药物的库存情况进行观察。在每个调查期间，对抗疟药客户进行了退出访谈。所有商店和设施都以地理位置为参考，并计算了与人口密度和与配送中心、道路和其他设施的接近程度相关的变量。为了了解影响的公平性，根据地理和社会经济变量，将备有ACTs的商店和购买ACTs的消费者与未购买ACTs的商店进行了比较。对照其他常见抗疟药的库存和销售模式进行了评估，以确定可能影响获取的因素。定性数据被用来评估潜在的库存、分配和购买差异的动机。结果：结果表明，尽管在试点过程中，ACT的总采购量从微不足道的水平上升到占抗疟药总销售的近一半，但库存和销售的相当大的地理差异持续存在，并与各种社会空间因素有关；ACTs更常在离区县城镇较近的商店里进货
Background: Millions of individuals with malaria-like fevers purchase drugs from private retailers, but artemisinin-based combination therapies (ACTs), the only effective treatment in regions with high levels of resistance to older drugs, are rarely obtained through these outlets due to their relatively high cost. To encourage scale up of ACTs, the Affordable Medicines Facility - malaria is being launched to subsidize their price. The Government of Tanzania and the Clinton Foundation piloted this subsidized distribution model in two Tanzanian districts to examine concerns about whether the intervention will successfully reach poor, rural communities.Methods: Stocking of ACTs and other antimalarial drugs in all retail shops was observed at baseline and in four subsequent surveys over 15 months. Exit interviews were conducted with antimalarial drug customers during each survey period. All shops and facilities were georeferenced, and variables related to population density and proximity to distribution hubs, roads, and other facilities were calculated. To understand the equity of impact, shops stocking ACTs and consumers buying them were compared to those that did not, according to geographic and socioeconomic variables. Patterning in ACT stocking and sales was evaluated against that of other common antimalarials to identify factors that may have impacted access. Qualitative data were used to assess motivations underlying stocking, distribution, and buying disparities.Results: Results indicated that although total ACT purchases rose from negligible levels to nearly half of total antimalarial sales over the course of the pilot, considerable geographic variation in stocking and sales persisted and was related to a variety of socio-spatial factors; ACTs were stocked more often in shops located closer to district towns (p