Research influence on antimalarial drug policy change in Tanzania: case study of replacing chloroquine with sulfadoxine-pyrimethamine as the first-line drug.
Research influence on antimalarial drug policy change in Tanzania: case study of replacing chloroquine with sulfadoxine-pyrimethamine as the first-line drug.
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DOI：
10.1186/1475-2875-4-51
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发表时间：
2005-10-20
期刊：
影响因子：
3
通讯作者：
Gonzalez-Block MA
中科院分区：
文献类型：
--
作者：
Mubyazi GM;Gonzalez-Block MA
研究是应对扩大干预措施和改善获得服务机会的挑战的重要工具。与许多其他国家一样，坦桑尼亚将研究证据转化为药物政策行动的工作常常受到以下因素的限制：研究人员和政策决策者之间沟通不通畅、个人对药物的看法或态度，以及一些政策决策者在预期如果按照建议改变政策可能产生不良后果时，不愿批准改变。在国际上，关于研究人员在国家抗疟药物政策变化中的作用的文献是有限的。描述(a)研究人员在提供影响坦桑尼亚政府以磺胺多辛-乙胺嘧啶（SP）取代氯喹（CQ）作为一线药物的证据方面所发挥的作用，以及在说服决策者、全科医生、制药行业和公众相信需要进行变革方面所面临的挑战(b)在坦桑尼亚引入新的药物联合治疗政策之前面临的挑战。对国家一级的决策者、疟疾控制方案管理人员、药品干事、普通医生、医学研究图书馆和出版物干事、大学院士、医学研究机构负责人以及地区和区域医务干事进行了深入访谈。通过审查疟疾药物政策文件获得了更多的数据，并进行了参与者的观察。2001年，坦桑尼亚政府正式改变了其疟疾治疗政策指南，将长期以来作为一线药物的CQ换成了SP。这一政策决定得到了研究证据的支持，研究证据表明，与SP和阿莫地喹相比，寄生虫对CQ的耐药性和临床CQ治疗失败率已达到无法容忍的水平。研究还表明，由于SP也面临耐药性上升的趋势，对更有效的药物的需求是必不可少的，但在过渡的5-10年期间，推荐相对于CQ和AQ更具成本效益的SP是合理的。考虑到正在进行有关青蒿素药物联合疗法的疗效和成本效益的研究（经卫生部伦理批准），政府启动了政策变化。然而，在向决策当局传达研究结果和建议的过程中，涉及决策者与研究人员之间、研究人员自己之间以及研究人员与全科医生之间的关键辩论，关于SP副作用的猜测性媒体报道以及公众对政策改变的理由、改变的时间和选择哪种药物的保留意见。改变国家毒品政策仍将是一个敏感问题，不可能一蹴而就。然而，为了确保研究结果得到认可，并有效利用这些发现所产生的建议，所有关键利益攸关方（包括决策者、药品制造商、媒体、从业人员和公众）在研究的各个阶段的系统参与至关重要。如何以及何时将研究信息传达给利益相关者也很重要。像东非疟疾治疗网络这样的专业组织有可能把疟疾研究人员、决策者和其他利益相关者聚集在一起，实现从研究到药物的政策改变。
Research is an essential tool in facing the challenges of scaling up interventions and improving access to services. As in many other countries, the translation of research evidence into drug policy action in Tanzania is often constrained by poor communication between researchers and policy decision-makers, individual perceptions or attitudes towards the drug and hesitation by some policy decision-makers to approve change when they anticipate possible undesirable repercussions should the policy change as proposed. Internationally, literature on the role of researchers on national antimalarial drug policy change is limited. To describe the (a) role of researchers in producing evidence that influenced the Tanzanian government replace chloroquine (CQ) with sulfadoxine-pyrimethamine (SP) as the first-line drug and the challenges faced in convincing policy-makers, general practitioners, pharmaceutical industry and the general public on the need for change (b) challenges ahead before a new drug combination treatment policy is introduced in Tanzania. In-depth interviews were held with national-level policy-makers, malaria control programme managers, pharmaceutical officers, general medical practitioners, medical research library and publications officers, university academicians, heads of medical research institutions and district and regional medical officers. Additional data were obtained through a review of malaria drug policy documents and participant observations were also done. In year 2001, the Tanzanian Government officially changed its malaria treatment policy guidelines whereby CQ – the first-line drug for a long time was replaced with SP. This policy decision was supported by research evidence indicating parasite resistance to CQ and clinical CQ treatment failure rates to have reached intolerable levels as compared to SP and amodiaquine (AQ). Research also indicated that since SP was also facing rising resistance trend, the need for a more effective drug was indispensable but for an interim 5–10 year period it was justifiable to recommend SP that was relatively more cost-effective than CQ and AQ. The government launched the policy change considering that studies (ethically approved by the Ministry of Health) on therapeutic efficacy and cost-effectiveness of artemisinin drug combination therapies were underway. Nevertheless, the process of communicating research results and recommendations to policy-making authorities involved critical debates between policy makers and researchers, among the researchers themselves and between the researchers and general practitioners, the speculative media reports on SP side-effects and reservations by the general public concerning the rationale for policy change, when to change, and to which drug of choice. Changing national drug policy will remain a sensitive issue that cannot be done overnight. However, to ensure that research findings are recognised and the recommendations emanating from such findings are effectively utilized, a systematic involvement of all the key stakeholders (including policy-makers, drug manufacturers, media, practitioners and the general public) at all stages of research is crucial. It also matters how and when research information is communicated to the stakeholders. Professional organizations such as the East African Network on Malaria Treatment have potential to bring together malaria researchers, policy-makers and other stakeholders in the research-to-drug policy change interface.
DOI：
10.1016/0035-9203(57)90039-1
发表时间：
1957-01-01
期刊：
TRANS ROY SOC TROP MED AND HYG
影响因子：
--
作者：
CLYDE, D. F.;SHUTE, G. T.
通讯作者：
SHUTE, G. T.
影响因子：
168.9
作者：
Mutabingwa, T;Nzila, A;Watkins, W
通讯作者：
Watkins, W
DOI：
10.1016/s0035-9203(01)90207-x
发表时间：
2001-07-01
影响因子：
2.2
作者：
Mutabingwa, TK;Maxwell, CA;Curtis, CF
通讯作者：
Curtis, CF