Improving Access to Self-Expanding Metal Stents for Patients With Esophageal Cancer in Eastern Africa: A Stepwise Implementation Strategy.
Improving Access to Self-Expanding Metal Stents for Patients With Esophageal Cancer in Eastern Africa: A Stepwise Implementation Strategy.
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DOI：
10.1200/go.20.00318
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发表时间：
2021-01
影响因子：
4.5
通讯作者：
Van Loon K
中科院分区：
文献类型：
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作者：
Mushi BP;Mwachiro MM;Buckle G;Kaimila BN;Mulima G;Kayamba V;Kelly P;Akoko L;Mmbaga EJ;Selekwa M;Ringo Y;Pritchett N;White RE;Topazian MD;Fleischer DE;Dawsey SM;Van Loon K
非洲东部走廊受到食道癌(EC)高负担的影响，90%的患者表现为晚期疾病。自膨式金属支架(SEMS)此前被报道为在资源有限的情况下缓解恶性吞咽困难的安全有效的方法；然而，在整个东非地区，获得这种支架的机会有限。针对食道癌对吞咽困难患者进行姑息性干预的需求，非洲食道癌联合会(AfrECC)与克林顿健康获取倡议合作，改善东非获得SEMS的机会。我们采取了一种循序渐进的实施方法，以(1)确定进入SEMS的障碍，(2)进行市场分析，(3)选择行业合作伙伴，(4)建立监管和采购程序，(5)开发内窥镜培训资源，(6)创建医疗器械登记，以及(7)建立问责原则。在对市场需求和潜在的SEMS制造商进行评估后，波士顿科学公司宣布承诺推出一项接入计划，以补贴价格向坦桑尼亚、肯尼亚、马拉维和赞比亚的患者提供食道SEMS。每个参与国都建立了平行的管理和采购程序。采用培训员培训模式，设计并实施内窥镜检查培训课程。建立了设备登记处，以集中数据进行质量控制，并监测SEMS分发渠道。制订了问责原则，以指导这一努力的可持续性。AfrECC支架获取倡议是建立多部门伙伴关系的一个例子，目的是提供一个创新的解决方案，使区域需求与高度优先的医疗设备的供应链保持一致。
The eastern corridor of Africa is affected by a high burden of esophageal cancer (EC), with > 90% of patients presenting with advanced disease. Self-expanding metal stents (SEMS) have been previously reported as safe and effective for palliation of malignant dysphagia in resource-limited settings; however, access is limited throughout Eastern Africa. In response to demand for palliative interventions for patients with dysphagia because of EC, the African Esophageal Cancer Consortium (AfrECC) partnered with the Clinton Health Access Initiative to improve access to SEMS in Eastern Africa. We undertook a stepwise implementation approach to (1) identify barriers to SEMS access, (2) conduct a market analysis, (3) select an industry partner, (4) establish regulatory and procurement processes, (5) develop endoscopic training resources, (6) create a medical device registry, and (7) establish principles of accountability. Following an evaluation of market demand and potential SEMS manufacturers, Boston Scientific Corporation announced its commitment to launch an access program to provide esophageal SEMS to patients in Tanzania, Kenya, Malawi, and Zambia at a subsidized price. Parallel regulatory and procurement processes were established in each participating country. Endoscopy training courses were designed and conducted, using the Training-of-Trainers model. A device registry was created to centralize data for quality control and to monitor channels of SEMS distribution. Principles of accountability were developed to guide the sustainability of this endeavor. The AfrECC Stent Access Initiative is an example of a multisector partnership formed to provide an innovative solution to align regional needs with a supply chain for a high-priority medical device.
DOI：
10.1016/j.vgie.2017.07.013
发表时间：
2017-11
期刊：
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy
影响因子：
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作者：
Mwachiro MM;Parker RK;Chepkwony R;Burgert SL;White RE
通讯作者：
White RE