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Homedes N, Fugh‐Berman A. Pharmacies and the Pharmaceutical Industry in Latin America. WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sinopoulou V, Gordon M, Rutter P. A systematic review of community pharmacies' staff diagnostic assessment and performance in patient consultations. Res Social Adm Pharm 2018; 15:1068-1079. [PMID: 30342907 DOI: 10.1016/j.sapharm.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Increases in patients seeking advice at pharmacies has led to pharmacy staff engaging in diagnostic behaviours. Approaches to diagnosis include using mnemonics and clinical reasoning. OBJECTIVES The primary aim of this review was to assess the degree to which the criteria researchers use to evaluate diagnostic performance in pharmacy consultations, in studies that have simulated patients or vignettes, conform with a clinical reasoning and a mnemonic framework. A secondary aim of the review was to characterize staff performance in the studies, based on the authors' comments of their results. METHODS MEDLINE, EMBASE and Web of Science were searched between October 2016 and April 2017. Only peer-reviewed studies assessing pharmacy staff's diagnostic performance using simulated patients or vignettes were eligible for inclusion. Data were extracted about how each study's criteria conformed with clinical reasoning and mnemonic frameworks. A scoring system between 0 and 4 was devised to determine the degree to which studies aligned to these two approaches. Risk of bias was assessed using the NHI Study Quality Assessment Tools. The review was registered in PROSPERO with identification number CRD42017054827. RESULTS Sixty-eight studies (55 cross-sectional, 11 educational interventions and 2 RCTs) with sample sizes between 10 and 2700 were included in the review. Most studies were of poor or fair quality. Performance of pharmacy staff was overwhelmingly reported as poor by study authors. This was the case regardless of geography, scenario used, or assessment framework adopted. Scrutiny on how authors arrived at these conclusions revealed that mnemonic criteria were employed to assess pharmacy staff's diagnostic performance rather than a clinical reasoning approach. CONCLUSIONS Potentially important aspects of the decision-making process, such as clinical reasoning, were left unexplored. The number and geographic distribution of the included studies is a strength of this review; however, a validated tool was not employed.
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Affiliation(s)
- Vassiliki Sinopoulou
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, United Kingdom.
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, United Kingdom
| | - Paul Rutter
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, United Kingdom
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Smith MCJ, Yin HS, Sanders LM. Lost in translation: Medication labeling for immigrant families. J Am Pharm Assoc (2003) 2016; 56:677-679. [PMID: 27836127 DOI: 10.1016/j.japh.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 06/20/2016] [Accepted: 07/03/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To identify the patient-safety hazards of current medication labeling standards for immigrant and language-minority families. SUMMARY The Latino population in the United States has increased by more than 40% over the past decade and the total child population born to Latino parents will surpass one-half of the population in many states. With recent health care and immigration policies, this demographic shift has a disproportional effect on the Latino families. Research shows that recent Latin American immigrants face disparities when encountering the U.S. pharmacy system. A review of these disparities shows how new policies should be informed when considering new pharmacy regulations to better address the cultural needs of recent Latin American families to improve medication understanding and adherence. CONCLUSION To date, research and regulatory requirements for medication safety in the United States have attended insufficiently to the patient-safety risk inherent in providing complex English-language labels to non-English-speaking families, many of whom have limited literacy in their native language. As families move, this patient-safety risk is increased by shifts in pharmacies, which often have different medication-labeling standards. It is important to examine how recent immigrant parents are addressing the medication needs for their children based on their cultural norms and how those cultural practices and acculturation into the U.S. health care system may affect their risk for injury. New research and policy efforts may help to address these barriers to safe medication use.
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Brata C, Gudka S, Schneider CR, Clifford RM. A review of the provision of appropriate advice by pharmacy staff for self-medication in developing countries. Res Social Adm Pharm 2014; 11:136-53. [PMID: 25139059 DOI: 10.1016/j.sapharm.2014.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/11/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients in developing countries often prefer to self-medicate via community pharmacies. Pharmacy staff are therefore in a strategic position to optimize the health of the public by providing appropriate advice to patients who self-medicate. OBJECTIVE To determine the proportion of pharmacy staff who provide appropriate advice when handling self-medication requests in developing countries. METHOD A literature search was undertaken via MEDLINE, EMBASE, CINAHL Plus, Web of Science and International Pharmaceutical Abstracts. Studies that reported on the proportion of pharmacy staff providing appropriate advice when handling self-medication requests in developing countries were included. The appropriateness of advice was determined by each author's definition in the original studies. RESULTS Twenty-eight studies met the inclusion criteria. There were variations in methods, scenarios, how the authors reported and defined appropriate advice, and study populations. The proportion of pharmacy staff providing appropriate advice varied widely from 0% to 96%, with a minority providing appropriate advice in 83% of the scenarios performed. CONCLUSION There was considerable variation in results, with the majority of studies reporting that inappropriate advice was provided by pharmacy staff when handling self-medication requests in developing countries. Consistent and robust methods are required to provide comparisons across practice settings. There is also a need to identify contributing factors to poor provision of advice for developing intervention strategies for practice improvement.
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Affiliation(s)
- Cecilia Brata
- Pharmacy, School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia; Centre of Medicine Information and Pharmaceutical Care, The University of Surabaya, Surabaya, Indonesia.
| | - Sajni Gudka
- Pharmacy, School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Carl R Schneider
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Rhonda M Clifford
- Pharmacy, School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
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Malik M, Hassali MA, Shafie AA, Hussain A, Aljadhey H, Saleem F. Case management of malaria fever at community pharmacies in Pakistan: a threat to rational drug use. Pharm Pract (Granada) 2013; 11:8-16. [PMID: 24155844 PMCID: PMC3780510 DOI: 10.4321/s1886-36552013000100003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/22/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To document the case management of uncomplicated malaria fever at community pharmacies located in the two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city). METHODS A comparative, cross-sectional study was designed to document the management of uncomplicated malaria fever at community pharmacies in twin cities of Pakistan through simulated patient visits. Visits were conducted in 238 randomly selected pharmacies to request advice for a simulated patient case of malaria. The pharmacy's management was scored on a checklist including history taking and provision of advice and information. Kruskal-Wallis test and Mann-Whitney U test were used to compare management of uncomplicated malaria fever by different types of dispensers working at community pharmacies situated at different locations in the twin cities. RESULTS The simulated patients were handled by salesmen (74.8%, n=178), pharmacist (5.4%, n=13) and diploma holders (19.8 %, n=47). Medication was dispensed in 83.1 % (n=198) of the visits, but only few of the treated cases were in accordance to standard treatment guidelines for malaria. However, in 14.8% (n=35) of the cases the simulated patients were directly referred to a physician. There was a significant difference observed in the process of history taking performed by different dispensers (e.g. pharmacist, pharmacy assistant, pharmacy diploma holders and salesman) while no significant differences in the provision of advice by these dispensers was observed. Pharmacists were seen more frequently involved in the process of history taking if available at the community pharmacies. On the other hand, no significant differences were observed in the case management (history taking and provision of advice) for the treatment of malaria fever among community pharmacies situated at different locations (e.g. near hospital/super market/small market) in the twin cities. CONCLUSIONS The results of the study revealed that the overall process of disease management of uncomplicated malaria fever at community pharmacies was not in accordance with the national standard treatment guidelines for malaria. Patients were being treated by untrained personnel's at community pharmacies without any understanding of referral. However, pharmacists were more frequently involved in history taking, though their availability was low at community pharmacies.
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Affiliation(s)
- Madeeha Malik
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia. Penang, (Malaysia) & Hamdard Institute of Pharmaceutical Sciences, Hamdard University. Islamabad, (Pakistan)
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García PJ, Carcamo CP, Garnett GP, Campos PE, Holmes KK. Improved STD syndrome management by a network of clinicians and pharmacy workers in Peru: The PREVEN Network. PLoS One 2012; 7:e47750. [PMID: 23082208 PMCID: PMC3474757 DOI: 10.1371/journal.pone.0047750] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 09/20/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sexually Transmitted diseases (STD) syndrome management has been one cornerstone of STD treatment. Persons with STD symptoms in many countries, especially those with limited resources, often initially seek care in pharmacies. The objective of the study was to develop and evaluate an integrated network of physicians, midwives and pharmacy workers trained in STD syndromic management (The PREVEN Network) as part of a national urban community-randomized trial of sexually transmitted infection prevention in Peru. METHODS AND FINDINGS After a comprehensive census of physicians, midwives, and pharmacies in ten intervention and ten control cities, we introduced seminars and workshops for pharmacy workers, and continuing education for physicians and midwives in intervention cities and invited graduates to join the PREVEN Network. "Prevention Salespersons" visited pharmacies, boticas and clinicians regularly for educational support and collection of information on numbers of cases of STD syndromes seen at pharmacies and by clinicians in intervention cities. Simulated patients evaluated outcomes of training of pharmacy workers with respect to adequate STD syndrome management, recommendations for condom use and for treatment of partners. In intervention cities we trained, certified, and incorporated into the PREVEN Network the workers at 623 (80.6%) of 773 pharmacies and 701 (69.6%) of 1007 physicians and midwives in private practice. Extremely high clinician and pharmacy worker turnover, 13.4% and 44% respectively in the first year, dictated continued training of new pharmacy workers and clinicians. By the end of the intervention the Network included 792 pharmacies and 597 clinicians. Pharmacies reported more cases of STDs than did clinicians. Evaluations by simulated patients showed significant and substantial improvements in the management of STD syndromes at pharmacies in intervention cities but not in control cities. CONCLUSIONS Training pharmacy workers linked to a referral network of clinicians proved feasible and acceptable. High turn-over was challenging but over come.
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Affiliation(s)
- Patricia J García
- Epidemiology, STI/AIDS Unit, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Fuentes D. An elective course in differential diagnostics. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2011; 75:185. [PMID: 22171113 PMCID: PMC3230346 DOI: 10.5688/ajpe759185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 07/05/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To design an elective course to teach the principles of differential diagnostics to second-year pharmacy students, critically evaluate the benefits of this approach to self-directed learning, and assess obstacles to implementation that other programs may encounter. DESIGN Students attended seven 2-hour class sessions in which the instructor presented a chief complaint, and the class researched and discussed possible causes and arrived at the accurate diagnosis. Each student also was assigned a unique, simulated patient case to work on outside of class. Students asked questions and researched the answers, providing a written rationale for needing the information and the source of the information. Students gave a 10-minute presentation on their diagnosis and treatment recommendations during the last class session. ASSESSMENT All students (N = 21) successfully determined their patients' diagnoses and made appropriate treatment recommendations. Fifteen students reported that the most valuable information in solving their case was subjective rather than objective in nature (ie, interviewing the patient rather than reviewing laboratory test results). The majority of the 15 students who completed a post-course survey instrument agreed or strongly agreed that this elective allowed them to practice varied skill sets and integrate past and future curricular content. CONCLUSION PharmD students may benefit from instruction in the basic principles of differential diagnostics.
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Affiliation(s)
- David Fuentes
- College of Pharmacy, Roosevelt University, Schaumberg, IL 60173, USA.
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Gupta A, Sane SS, Gurbani A, Bollinger RC, Mehendale SM, Godbole SV. Stigmatizing attitudes and low levels of knowledge but high willingness to participate in HIV management: a community-based survey of pharmacies in Pune, India. BMC Public Health 2010; 10:517. [PMID: 20799948 PMCID: PMC2939646 DOI: 10.1186/1471-2458-10-517] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 08/27/2010] [Indexed: 11/16/2022] Open
Abstract
Background The World Health Organization (WHO) recommends that the role of pharmacists in low-income settings be expanded to address the increasing complexity of HIV antiretroviral (ARV) and co-infection drug regimens. However, in many such settings including in India, many pharmacists and pharmacy workers are often neither well trained nor aware of the intricacies of HIV treatment. The aims of our study were; to determine the availability of ARVs, provision of ARVs, knowledge about ARVs, attitudes towards HIV-infected persons and self-perceived need for training among community-based pharmacies in an urban area of India. Methods We performed a survey of randomly selected, community-based pharmacies located in Pune, India, in 2004-2005 to determine the availability of ARVs at these pharmacies, how they were providing ARVs and their self-perceived need for training. We also assessed knowledge, attitudes and perceptions on HIV and ARVs and factors associated with stocking ARVs. Results Of 207 pharmacies included in the survey, 200 (96.6%) were single, private establishments. Seventy-three (35.3%) pharmacies stocked ARVs and 38 (18.4%) ordered ARVs upon request. The reported median number of ARV pills that patients bought at one time was 30, a two week supply of ARVs (range: 3-240 pills). Six (2.9%) pharmacy respondents reported selling non-allopathic medicines (i.e. Ayurvedic, homeopathy) for HIV. Ninety (44.2%) pharmacy respondents knew that ARVs cannot cure HIV, with those stocking ARVs being more likely to respond correctly (60.3% vs. 34.8%, p = 0.001). Respondents of pharmacies which stocked ARVs were also more likely to believe it was a professional obligation to provide medications to HIV-infected persons (91.8% vs. 78.8%, p = 0.007) but they were also more likely to believe that HIV-infected persons are unable to adhere to their medicines (79.5% vs. 40.9%, p < 0.01). Knowledge of the most common side effects of nevirapine, abnormal liver enzyme profile and skin rash, was reported correctly by 8 (3.9%) and 23 (11.1%) respondents, respectively. Seven (3.4%) respondents reported that they had received special training on HIV, 3 (1.5%) reported receipt of special training on ART and 167 (80.7%) reported that they believed that pharmacy staff should get special training on ART. Conclusion There is a high willingness to participate in HIV management among community-based pharmacies but there is a tremendous need for training on HIV therapies. Furthermore, stigmatizing attitudes towards HIV-infected persons persist and interventions to reduce stigma are needed, particularly among those that stock ARVs.
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Affiliation(s)
- Amita Gupta
- Johns Hopkins School of Medicine, Johns Hopkins University, Phipps 540, 600 N, Wolfe Street, Baltimore, Maryland 21287, USA.
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Pharmacy worker practices related to use of misoprostol for abortion in one Mexican state. Contraception 2009; 79:445-51. [DOI: 10.1016/j.contraception.2008.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 12/23/2008] [Accepted: 12/23/2008] [Indexed: 11/19/2022]
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Smith F. The quality of private pharmacy services in low and middle-income countries: a systematic review. ACTA ACUST UNITED AC 2009; 31:351-61. [PMID: 19343530 DOI: 10.1007/s11096-009-9294-z] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 03/25/2009] [Indexed: 10/21/2022]
Abstract
AIM OF THE REVIEW In low and middle income countries private pharmacies are considered a valuable resource for health advice and medicines in many communities. However the quality of the service they provide has often been questioned and is unclear. This paper reviews the evidence regarding the quality of professional services from private pharmacies in low and middle-income countries. METHOD A literature search (computer and hand searches) was undertaken to identify all studies which included an assessment of the quality of some aspect of private pharmacy services in low and middle income countries. RESULTS 30 studies were identified which spanned all regions in the developing world. These included 9 which examined the scope and/or quality of a range of professional services, 14 which assessed the quality of advice provided in response to specific symptoms and 7 which investigated the supply of medicines without a prescription. A range of methods were employed, in particular, questionnaire surveys with staff and/or clients and assessment of practice using simulated client methodology. Whilst many authors identified a potential for pharmacies to contribute more effectively to primary health care, virtually all studies identified deficiencies in the quality of current professional practice. In particular authors highlighted the lack of presence of pharmacists or other trained personnel, the provision of advice for common symptoms which was not in accordance with guidelines and the inappropriate supply of medicines. CONCLUSION The evidence-base regarding the quality of professional services from pharmacies in low and middle income countries is limited, but indicates that standards are often deficient. If pharmacists are to contribute effectively to health care, the barriers to the provision of higher quality care and ways in which these might be overcome must be identified and examined.
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Affiliation(s)
- Felicity Smith
- Department of Practice and Policy, School of Pharmacy, University of London, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, UK.
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Cross-Border Purchase of Medications and Health Care in a Sample of Residents of El Paso, Texas, and Ciudad Juarez, Mexico. J Natl Med Assoc 2009; 101:167-73. [DOI: 10.1016/s0027-9684(15)30831-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wirtz VJ, Taxis K, Dreser A. Pharmacy customers’ knowledge of side effects of purchased medicines in Mexico. Trop Med Int Health 2009; 14:93-100. [DOI: 10.1111/j.1365-3156.2008.02186.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Provider characteristics among staff providing care to sexually transmitted infection self-medicating patients in retail pharmacies in Kibera slum, Nairobi, Kenya. Sex Transm Dis 2008; 35:480-3. [PMID: 18360315 DOI: 10.1097/olq.0b013e3181644b84] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the characteristics of providers in management of STI self-medicating patients in retail pharmacies within the largest informal settlement in Kenya. METHODS We collected sociodemographic, training, and work history attributes among pharmacy staff from a convenience sample of 50 retail pharmacies in Kibera slum using a self-administered questionnaire. We gathered the required data in 8 weeks, collecting completed self-administered questionnaires within 7 to 14 days after distribution. Two data collectors subsequently presented at these pharmacies as mystery patients seeking care for symptoms of genital ulcer disease and gonorrhea and completed a structured observation form within 10 minutes of leaving the pharmacy. RESULTS Approximately half the respondents were men aged less than 28 years. Over 90% had 12 years of formal education and an additional 3 years of medical professional training. Two thirds (66%) had been trained in Government institutions. About 65% reported that patients presented without prescriptions, and 45% noted that patients requested specific medicines but were open to advice. One-third (36%) of the patients used the pharmacy as their first point of care. Using mystery patients to evaluate syndromic management of gonorrhea and genital ulcer disease, only 10% offered appropriate treatment per the Kenya Ministry of Health STI syndromic management guidelines. CONCLUSION Although the majority of the pharmacy staff in this informal settlement have some medical training and some experience, a very low proportion offered adequate treatment for 2 common STIs.
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Hoffman S, Cooper D, Ramjee G, Higgins JA, Mantell JE. Microbicide acceptability: insights for future directions from providers and policy makers. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2008; 20:188-202. [PMID: 18433323 DOI: 10.1521/aeap.2008.20.2.188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
To help fill the gap concerning health care providers' and policy makers' knowledge of and views concerning microbicides, we compared data from one U.S. study and two South African studies that explored these issues. Frontline providers in South Africa were enthusiastic about any method that would have the potential to slow the HIV/AIDS epidemic, whereas providers in New York City and policy makers in South Africa balanced their enthusiasm with more concerns. Across all studies, participants wanted timely and accurate scientific information, and they raised issues about safety, "messiness," and cost. Many had difficulty understanding that promoting a partially effective method can reduce risk if a client uses it more often than a highly effective method. Microbicide advocates need to effectively communicate to providers the evidence-based findings from microbicide trials and find approaches to introduce concepts such as "harm reduction" and "prevention equation" perspectives in client counseling. Developing these approaches will maximize the positive influence that providers can exert on user acceptability of microbicides once they become available.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY 10032, USA.
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Morris CN, Ferguson AG. Sexual and treatment-seeking behaviour for sexually transmitted infection in long-distance transport workers of East Africa. Sex Transm Infect 2007; 83:242-5. [PMID: 17314124 PMCID: PMC2659098 DOI: 10.1136/sti.2006.024117] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the sexual and treatment-seeking behaviour for sexually transmitted infection (STI) in long-distance transport workers of East Africa. METHODS A health-seeking behaviour survey was carried out at four sites on the Mombasa-Kampala trans-Africa highway (n = 381). The questionnaires probed details of STI knowledge, symptoms and care-seeking behaviour. In one site at the Kenya-Uganda border, a sexual patterning matrix was used (n = 202) to measure sexual behaviour in truck drivers and their assistants over the 12-month period before the interview. RESULTS Over half of the sexual acts of long-distance transport workers over 12 months were with female sex workers, with an annual average of 2.8 sexual partners. Condom use was reported at 70% for liaisons with casual partners. 15% of truckers had had a self-reported STI and one-third exhibited high-risk sexual behaviour in the previous year. Of those with an STI, 85% had symptoms when on the road and 77.2% sought treatment within 1 week of onset of symptoms. 94% of drivers and 56% of assistants sought treatment for STI in a private health facility or pharmacy. The cost of private facilities and pharmacies was not significantly higher than in the public sector. Waiting times were three times longer in the public sector. Only 28.9% of patients completed their medication courses as prescribed. CONCLUSIONS Truck drivers and their assistants in East Africa have high rates of reported STIs and many continue to exhibit high-risk sexual behaviour. The transport workers studied here favoured private health facilities because of convenience and shorter waiting times.
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Affiliation(s)
- Chester N Morris
- Department of Medical Microbiology, University of Manitoba, Institute for Human Virology-Nigeria, Maina Court, Herbert McCauley Way, Abuja 111111, Nigeria.
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Lara D, Abuabara K, Grossman D, Díaz-Olavarrieta C. Pharmacy provision of medical abortifacients in a Latin American city. Contraception 2006; 74:394-9. [PMID: 17046381 DOI: 10.1016/j.contraception.2006.05.068] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 04/07/2006] [Accepted: 05/01/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE Access to legal abortion services is restricted in Latin America. Nonetheless, previous research suggest that women frequently use misoprostol to self-induce abortion. In many settings, women obtain the medication from a pharmacy. This study was conducted to better understand pharmacy staff knowledge and provision practices of misoprostol and other medical abortifacients. METHODS We first interviewed staff at a random sample of 102 pharmacies in a Latin American city. Mystery clients were subsequently sent to the same pharmacies to ascertain prescribing practices and counseling. RESULTS Nearly half of the pharmacy staff interviewed reported that they were familiar with at least one abortifacient, and an abortifacient was recommended in 74% of the mystery client encounters. Hormonal injections were most frequently recommended as abortifacients in the survey (67%) and the mystery client encounters (71%), followed by misoprostol (60% and 39%, respectively). Few of the pharmacy staff (6% in the survey and 17% in the mystery client encounters) recommended a misoprostol dosing regimen that is potentially effective. CONCLUSION Abortifacient provision is common at pharmacies but knowledge about medications is low among pharmacy staff.
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Affiliation(s)
- Diana Lara
- Population Council, Regional Office for Latin America and the Caribbean, Mexico City 04000, Mexico.
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Cowan FM, French RS, Mayaud P, Gopal R, Robinson NJ, de Oliveira SA, Faillace T, Uusküla A, Nygård-Kibur M, Ramalingam S, Sridharan G, El Aouad R, Alami K, Rbai M, Sunil-Chandra NP, Brown DW. Seroepidemiological study of herpes simplex virus types 1 and 2 in Brazil, Estonia, India, Morocco, and Sri Lanka. Sex Transm Infect 2003; 79:286-90. [PMID: 12902576 PMCID: PMC1744730 DOI: 10.1136/sti.79.4.286] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The association between herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus (HIV) and the development of HSV vaccines have increased interest in the study of HSV epidemiology. OBJECTIVES To estimate the age and sex specific seroprevalence of HSV-1 and HSV-2 infections in selected populations in Brazil, Estonia, India, Morocco, and Sri Lanka. METHODS Serum samples were collected from various populations including children, antenatal clinic attenders, blood donors, hospital inpatients, and HIV sentinel surveillance groups. STD clinic attenders were enrolled in Sri Lanka, male military personnel in Morocco. Sera were tested using a common algorithm by type specific HSV-1 and HSV-2 antibody assay. RESULTS 13,986 samples were tested, 45.0% from adult females, 32.7% from adult males, and 22.3% from children. The prevalence of HSV-1 varied by site ranging from 78.5%-93.6% in adult males and from 75.5%-97.8% in adult females. In all countries HSV-1 seroprevalence increased significantly with age (p<0.001) in both men and women. The prevalence of HSV-2 infection varied between sites. Brazil had the highest age specific rates of infection for both men and women, followed by Sri Lanka for men and Estonia for women, the lowest rates being found in Estonia for men and India for women. In all countries, HSV-2 seroprevalence increased significantly with age (p<0.01) and adult females had higher rates of infection than adult males by age of infection. CONCLUSIONS HSV-1 and HSV-2 seroprevalence was consistently higher in women than men, particularly for HSV-2. Population based data on HSV-1 and HSV-2 will be useful for designing potential HSV-2 vaccination strategies and for focusing prevention efforts for HSV-1 and HSV-2 infection.
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Affiliation(s)
- F M Cowan
- Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College London, London, UK.
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