Time to embrace access programmes for medicines: lessons from the South African flucytosine access programme

International Journal of Infectious Diseases

Douglas Wilson¹  Nelesh P. Govender²  Carol Ruffell³  Gilles Van Cutsem⁴  Angela Loyse⁵  Amir Shroufi⁶  Richard A. Murphy⁶  Thomas Harrison⁷  Olawale Ajose⁸  Halima Dawood⁹  Mahomed-Yunus S. Moosa⁹  Jeremy Nel^1,10  Graeme Meintjes^1,11  John Black^1,12  Colin Menezes^1,13  Laura Trivino Duran^1,13 

[1] Chris Hani Baragwanath Hospital, Johannesburg, South Africa;Corresponding author: Amir Shroufi, Doctors Without Borders South Africa, Johannesburg, South Africa. E-mail: [e-mail];The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, USA;Centre for Global Health, Institute of Infection and Immunity, St George’s University of London, London, UK;David Geffen School of Medicine at UCLA, Los Angeles, USA;Doctors Without Borders South Africa, Johannesburg, South Africa;Drugs for Neglected Diseases Initiative, Los Angeles, USA;Edendale Hospital, Kwa Zulu Natal, South Africa;Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;Livingstone Hospital, Eastern Cape, South Africa;National Institute for Communicable Diseases, A Division of the National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa;University of Cape Town, Western Cape, South Africa;University of Kwa Zulu Natal, Kwa Zulu Natal, South Africa;

关键词: Flucytosine;    5FC;    Cryptococcal;    Cryptococcal meningitis;    Access;    Access programme;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Cryptococcal meningitis (CM) is estimated to cause 181 000 deaths annually, with the majority occurring in Sub-Saharan Africa. Flucytosine is recommended by the World Health Organization as part of the treatment for CM. Widespread use of flucytosine could reduce mortality in hospital by as much as 40% compared to the standard of care, yet due to market failure, quality-assured flucytosine remains unregistered and largely inaccessible throughout Africa. Methods: The recently established South African flucytosine clinical access programme is an attempt to address the market failure that led to a lack of public sector access to flucytosine for CM, by making the medicine freely available to tertiary hospitals in South Africa. Results: Between November 2018 and September 2019, 327 CM patients received flucytosine through this programme, with efforts to support sustainable national scale-up presently ongoing. We describe why this programme was needed, its catalytic potential, what is still required to ensure widespread access to flucytosine, and observations from this experience that may have wider relevance. Conclusions: The South African flucytosine access programme illustrates how access programmes may be one part of the solution to addressing the vicious cycle of perceived low demand, limiting manufacturer interest in specific product markets.

【 授权许可】

Unknown