Integration of drug safety monitoring in tuberculosis treatment programmes: country experiences

Facilitators and barriers in implementation of active TB drug safety monitoring and management (aDSM) in programmatic management of drug resistance TB in Dar es Salaam region

BACKGROUND

World Health Organization (WHO) recommends that active TB Dug Safety Monitoring and Management (aDSM) be adopted in countries' programmatic management of DR-TB services. In Tanzania, the National TB Leprosy Programme (NTLP), under the ministry of health, adopted the aDSM component in 2018. The study evaluated the facilitators and barriers of aDSM implementation in Dar es Salaam.

MATERIALS AND METHODS

This was a process evaluation study that adapted the descriptive cross-sectional approach, conducted in Dar es Salaam region. A total of 19 respondents, including clinicians, DOT (Direct Observed Therapy) nurses and key NTLP personnel, were interviewed using interview guides. Qualitative content analysis based on Graneheim & Lundman was used to guide the analysis.

RESULTS

For aDSM to be implemented in a health facility, tools like forms for recoding and reporting, access to a functional laboratory for carrying out the required monitoring tests are a necessity. Moreover, the NTLP monitors the implementation through received aDSM reports and DR-TB supportive supervisions. However, it was found that in many health facilities, aDSM was partially being implemented due to various barriers: inadequate trained staff for aDSM implementation, administrative burden in reporting and delaying in AE management.

CONCLUSION

aDSM is inadequately being implemented due to the many setbacks faced by HCWs. aDSM-specific supportive supervisions and trainings to HCWs; incorporating the current manual aDSM reporting flow into the already existing electronic (Tanzania Medicine and Medical Drugs Authority) TMDA database seems useful.

Clinical standards for the management of adverse effects during treatment for TB

BACKGROUND: Adverse effects (AE) to TB treatment cause morbidity, mortality and treatment interruption. The aim of these clinical standards is to encourage best practise for the diagnosis and management of AE.METHODS: 65/81 invited experts participated in a Delphi process using a 5-point Likert scale to score draft standards.RESULTS: We identified eight clinical standards. Each person commencing treatment for TB should: Standard 1, be counselled regarding AE before and during treatment; Standard 2, be evaluated for factors that might increase AE risk with regular review to actively identify and manage these; Standard 3, when AE occur, carefully assessed and possible allergic or hypersensitivity reactions considered; Standard 4, receive appropriate care to minimise morbidity and mortality associated with AE; Standard 5, be restarted on TB drugs after a serious AE according to a standardised protocol that includes active drug safety monitoring. In addition: Standard 6, healthcare workers should be trained on AE including how to counsel people undertaking TB treatment, as well as active AE monitoring and management; Standard 7, there should be active AE monitoring and reporting for all new TB drugs and regimens; and Standard 8, knowledge gaps identified from active AE monitoring should be systematically addressed through clinical research.CONCLUSION: These standards provide a person-centred, consensus-based approach to minimise the impact of AE during TB treatment.

Leveraging Experience From Active TB Drug-Safety Monitoring and Management for Monitoring Active Antiretroviral Toxicity

Systems established for active drug safety monitoring and management of drug-resistant TB should be leveraged to ensure comprehensive surveillance for active toxicity monitoring during scale-up of newer antiretroviral regimens.

Baseline assessment of pharmacovigilance activities in four sub-Saharan African countries: a perspective on tuberculosis

BACKGROUND

New medicines have become available for the treatment of drug-resistant tuberculosis (DR-TB) and are introduced in sub-Saharan Africa (SSA) by the national TB programs (NTPs) through special access schemes. Pharmacovigilance is typically the task of national medicines regulatory agencies (NMRAs), but the active drug safety monitoring and management (aDSM) recommended for the new TB medicines and regimens was introduced through the NTPs. We assessed the strengths and challenges of pharmacovigilance systems in Eswatini, Ethiopia, Nigeria and Tanzania, focusing on their capacity to monitor safety of medicines registered and not registered by the NMRAs for the treatment of DR-TB.

METHODS

Assessment visits were conducted to all four countries by a multidisciplinary team. We used a pharmacovigilance indicator tool derived from existing tools, interviewed key stakeholders, and visited health facilities where DR-TB patients were treated with new medicines. Assessment results were verified with the local NMRAs and NTPs.

RESULTS

Most countries have enabling laws, regulations and guidelines for the conduct of pharmacovigilance by the NMRAs. The relative success of NTP-NMRA collaboration is much influenced by interpersonal relationships between staff. Division of roles and responsibilities is not always clear and leads to duplication and unfulfilled tasks (e.g. causality assessment). The introduction of aDSM has increased awareness among DR-TB healthcare providers.

CONCLUSION

aDSM has created awareness about the importance of pharmacovigilance among NTPs. In the future, a push for conducting pharmacovigilance through public health programs seems useful, but this needs to coincide with increased collaboration with between public health programs and NMRAs with clear formulation of roles and responsibilities.