Artemisinin-based combination therapy availability and use in the private sector of five AMFm phase 1 countries.
Artemisinin-based combination therapy availability and use in the private sector of five AMFm phase 1 countries.
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DOI：
10.1186/1475-2875-12-135
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发表时间：
2013-04-22
期刊：
影响因子：
3
通讯作者：
Saba J
中科院分区：
文献类型：
--
作者：
Davis B;Ladner J;Sams K;Tekinturhan E;de Korte D;Saba J
2009年，全球抗击艾滋病、结核病和疟疾基金设立了负担得起的抗疟疾药品机制，以增加获得有质量保证的青蒿素综合疗法的机会。AMFm第一阶段于2009年启动，包括在8个国家开展的9个试点方案。本研究的目的是评估五个AMFM第一阶段国家私人销售点的抗疟药物库存和购买模式，以实现AMFM的三个核心目标：提高QAACT的可负担性，增加QAACT的可获得性，淘汰青蒿素单一疗法和其他不合格疗法。这项研究于2012年4月至5月进行，包括对加纳、肯尼亚、尼日利亚、坦桑尼亚和乌干达598家私营药店的工作人员进行采访。在私人零售店进行了问卷调查，并对数据进行了分析，以评估QAACT价格、可用性和受欢迎程度的国家内和国家间差异。AMFm药物比非AMFm药物便宜，但这两种药物的价格都高于各国的建议零售价。AMFm QAACT在城市和农村地区的市场渗透率都很高，尽管与加纳和肯尼亚的城市网点相比，AMFm和非AMFm产品的缺货在农村更常见（p = 0.0013）。政府推荐是影响城市（41.5%）和农村（31.9%）抗疟药库存选择的最重要因素。除乌干达农村地区和尼日利亚城市地区外，每个国家城市和农村地区报告的三种最畅销的抗疟疾药物是复方疗法。这项研究的结果表明，AMFm还没有完全实现其负担能力和挤出目标。尽管如此，AMFm QAACT的最终购买价格仍远低于非AMFm同类产品。此外，在城市和农村地区，AMFM QAACT的供应量很高，各种形式的QAACT是所有抗疟药物中最畅销的产品。这些研究结果表明，继续需要像AMFm这样的举措，以提高QAACT的可负担性和可获得性。如果与快速诊断检测结合使用，类似的方案可能特别有效，以确保这些产品的适当使用。
In 2009, the Global Fund to Fight AIDS, Tuberculosis and Malaria established the Affordable Medicines Facility-malaria (AMFm) in order to increase access to quality-assured artemisinin combination therapy (QAACT). AMFm Phase 1, which includes nine pilot programmes in eight countries, was launched in 2009. The objective of this study was to assess anti-malarial stock and purchase patterns at private outlets in five AMFm Phase 1 countries in regard to three of the core AMFm goals: increase the affordability of QAACT, increase the availability of QAACT, and crowd out artemisinin monotherapies and other substandard therapies. The study was conducted between April and May 2012 and included interviews with personnel in 598 private pharmaceutical outlets in Ghana, Kenya, Nigeria, Tanzania, and Uganda. Questionnaires were administered at private retail outlets and the data were analyzed to assess within- and between-country differences in QAACT price, availability, and popularity. AMFm medications were less expensive than their non-AMFm counterparts, yet prices for both types were above country-specific suggested retail prices. Market penetration of AMFm QAACT in both urban and rural areas was high, although stock-outs of both AMFm and non-AMFm products were more common in rural compared with urban outlets in Ghana and Kenya (p = 0.0013). Government recommendation was the most significant factor influencing anti-malarial stock choices in urban (41.5%) and rural (31.9%) outlets. The three top-selling anti-malarials reported for both urban and rural areas in each country were, with the exception of rural Uganda and urban Nigeria, combination therapies. Results from this study indicate that the AMFm has not fully achieved its affordability and crowd-out objectives. Still, the final purchase price of AMFm QAACT was substantially lower than non-AMFm equivalents. Moreover, for both urban and rural areas, AMFm QAACT availability was found to be high, and the various forms of QAACT were the best-selling products among all anti-malarials. These findings suggest a continued need for initiatives like the AMFm that improve the affordability and accessibility of QAACT. Similar programmes may be especially effective if employed in combination with rapid diagnostic testing to ensure the appropriate use of these products.
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