دورية أكاديمية
Striving towards access to essential medicines for human and animal health; a situational analysis of access to and use of antifungal medications for histoplasmosis in Ethiopia.
| العنوان: | Striving towards access to essential medicines for human and animal health; a situational analysis of access to and use of antifungal medications for histoplasmosis in Ethiopia. |
|---|---|
| المؤلفون: | Robertson E; Department of Livestock and One Health, Institute of Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom., Abera C; Histoplasmosis Research Group, Care of SPANA Bishoftu, Brooke Addis Ababa, Addis Ababa, Ethiopia., Wood K; Department of Livestock and One Health, Institute of Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom., Deressa K; Histoplasmosis Research Group, Care of SPANA Bishoftu, Brooke Addis Ababa, Addis Ababa, Ethiopia., Mesfin S; Independent Researcher, Addis Ababa, Ethiopia., Scantlebury C; Department of Livestock and One Health, Institute of Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom. |
| المصدر: | PloS one [PLoS One] 2023 Mar 09; Vol. 18 (3), pp. e0278964. Date of Electronic Publication: 2023 Mar 09 (Print Publication: 2023). |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: San Francisco, CA : Public Library of Science |
| مواضيع طبية MeSH: | Histoplasmosis*/drug therapy , Histoplasmosis*/epidemiology , Histoplasmosis*/veterinary , Drugs, Essential*, Humans ; Horses ; Animals ; Antifungal Agents/therapeutic use ; Ethiopia/epidemiology ; Animals, Domestic |
| مستخلص: | Antifungal medications are vital in combatting fungal diseases that affect over a billion people annually. Antifungal medications for people and equids are scarce in Ethiopia, where lack of resources to treat fungal infection, in particular histoplasmosis, is a major health challenge. Histoplasmosis is endemic within the equine population in Ethiopia, where it is estimated that one in five horses are infected. This disease has far reaching impacts on equine welfare and the socio-economic wellbeing of families. The burden of histoplasmosis in people in Ethiopia is currently unknown, representing a blind spot in public health surveillance. Previous research has identified contact with wildlife, and domestic animal species as possible transmission pathways for histoplasmosis however, questions remain about the role of equids in human histoplasmosis. Given the close proximity of people and animals in this setting, the high level of endemic disease among equids, and the common sources of anti-fungals in Ethiopia, our study adopted a One-Health approach to examine how systemic issues affect access to, and use of antifungals to treat histoplasmosis among people and equids. A qualitative study was conducted in 6 urban regions of Oromia, Ethiopia in December 2018, incorporating semi-structured face-to-face interviews and focus group discussions. Twenty-seven individual interviews were held with doctors (n = 7), pharmacists (n = 12), veterinarians (n = 5), para-veterinarians (n = 2) and an equid owner (n = 1). Eleven focus groups were conducted with equid owners (n = 42), 3 with veterinarians (n = 6), 1 with para-veterinarians (n = 2) and 1 with pharmacists (n = 2). Transcripts were analysed using thematic analysis, and dimensions of key themes conceptualised and compared. Two overarching themes namely, 'Structural', and 'Human factors', summarised the main limitations to access to antifungal medications. 'Structural factors' included the national reliance on importation of medicines or pharmaceutical ingredients, inaccurate demand forecasting due to poor recording of the shortfall within the pharmaceutical supply chain, deficiencies in diagnostic capacity for fungal disease and, a healthcare system funded with a significant component of out-of-pocket expenditure. 'Human factors' that influenced access to antifungals included the perception of the expense of antifungals compared with competing needs such as food and education, the social stigma attached to histoplasmosis that could lead to delays in treatment seeking and, readily available home remedies or alternative treatment options. Furthermore, it was reported that trust in healthcare and veterinary provisions was undermined by a perceived lack of efficacious medications. Access to antifungals remains an urgent public health and animal welfare concern in Ethiopia. Key points within the supply and distribution chain that affect access to anti-fungals are identified, and policies that facilitate anti-fungal procurement and distribution should be reviewed. This paper highlights the structural, socio-economic and cultural factors influencing the management of infection with histoplasmosis, including how it is understood, identified and treated. This study identifies areas where further cross-sectorial work is needed to address these factors to improve disease control and clinical outcomes observed in human and animal histoplasmosis within Ethiopia. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2023 Robertson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.) |
| References: | Front Vet Sci. 2021 Dec 10;8:762937. (PMID: 34970614) Int J STD AIDS. 2014 Aug;25(9):656-61. (PMID: 24598976) Rev Sci Tech. 1999 Dec;18(3):691-9. (PMID: 10588013) Am J Trop Med Hyg. 2014 Feb;90(2):216-23. (PMID: 24394475) BMC Vet Res. 2020 Oct 7;16(1):375. (PMID: 33028302) Clin Infect Dis. 2007 Oct 1;45(7):807-25. (PMID: 17806045) PLoS Negl Trop Dis. 2013 Nov 21;7(11):e2319. (PMID: 24278485) J Mycol Med. 2021 Mar;31(1):101120. (PMID: 33626442) Asian Pac J Trop Biomed. 2012 Jul;2(7):505-10. (PMID: 23569960) J Travel Med. 2013 Mar-Apr;20(2):83-7. (PMID: 23464714) PLoS Negl Trop Dis. 2018 Jan 18;12(1):e0006046. (PMID: 29346384) Lancet Infect Dis. 2018 Oct;18(10):1150-1159. (PMID: 30146320) Lancet Infect Dis. 2013 Jul;13(7):629-37. (PMID: 23735626) Prev Vet Med. 2015 Jul 1;120(3-4):265-76. (PMID: 25980831) J Antimicrob Chemother. 2016 Dec;71(12):3599-3606. (PMID: 27516477) Vet Rec. 2012 Sep 29;171(13):312-4. (PMID: 23023491) Nat Rev Microbiol. 2022 Sep;20(9):557-571. (PMID: 35352028) Front Vet Sci. 2021 Jun 16;8:673442. (PMID: 34222399) Clin Microbiol Rev. 2007 Jan;20(1):115-32. (PMID: 17223625) Am J Med. 1997 Sep;103(3):223-32. (PMID: 9316555) Cochrane Database Syst Rev. 2020 Apr 28;4:CD013594. (PMID: 32343003) Clin Infect Dis. 2000 Apr;30(4):688-95. (PMID: 10770731) Br J Clin Pharmacol. 2022 Sep;88(9):3936-3942. (PMID: 35342977) Ethiop J Health Sci. 2016 May;26(3):259-76. (PMID: 27358547) J Fungi (Basel). 2019 Aug 09;5(3):. (PMID: 31404979) J Fungi (Basel). 2017 Oct 18;3(4):. (PMID: 29371573) Ther Adv Infect Dis. 2021 Apr 9;8:20499361211008675. (PMID: 33889408) |
| معلومات مُعتمدة: | United Kingdom WT_ Wellcome Trust |
| المشرفين على المادة: | 0 (Antifungal Agents) 0 (Drugs, Essential) |
| تواريخ الأحداث: | Date Created: 20230309 Date Completed: 20230313 Latest Revision: 20230411 |
| رمز التحديث: | 20240829 |
| مُعرف محوري في PubMed: | PMC9997978 |
| DOI: | 10.1371/journal.pone.0278964 |
| PMID: | 36893127 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1932-6203 |
|---|---|
| DOI: | 10.1371/journal.pone.0278964 |