[procaare] Private Prescribing Biggest Risk for Developing Drug Resistance

[ProCAARE <procaare@healthnet.org>]

Private Prescribing Biggest Risk for Developing World Drug Resistance
- HealthLink Bulletin 20-06-2003
http://news.hst.org.za/view.php3?id=20030620
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Unless HIV treatment is properly controlled in developing countries, antiretroviral
therapy could become useless due to poor practice in the private sector, according to an
editorial in the June 21 edition of the British Medical Journal by Ruairi Brugha, a senior
lecturer in public health at the London School of Hygiene and Tropical Medicine.

He notes that most poor people who suspect they have a sexually transmitted infection seek
care in the private sector because of the stigma attached to the disease. However,
unpublished research carried out by Oxfam in Tanzania showed that this form of health
seeking behaviour was further structured by gender and age, with younger women least
likely to seek any sort of treatment, older women and younger men likely to consult
traditional healers, and older men most likely to go to private practitioners for
antibiotics.

There is considerable evidence that private sector prescribing is already a major route to
antiretroviral therapy in Africa, and that sub-optimal practice abounds. A study in
Zimbabwe carried out in 2000 found that 82% of the pharmacies found to stock HIV drugs
carried a single drug, and monotherapy was prescribed to 17% of patients.

Poor prescribing practice driven by the cost of the drugs is likely to continue wherever
differential pricing excludes the private sector. Whilst generous discounts for public
sector and NGO schemes have been highlighted by Indian generic manufacturers, individuals
accessing treatment through private practitioners are continuing to pay much higher prices
because the drugs available in pharmacies are either branded products or drugs diverted
from the public sector.

Although the author suggests that the main reason for accessing treatment through private
practitioners is to avoid the stigma of attending HIV clinics in public hospitals, the
uptake of antiretrovirals through private practitioners must also be related to the delays
in making treatment available through the public sector. Research from both Uganda and
Senegal shows that the major cause of treatment interruption or discontinuation is lack of
money.

Donors need to be more active in helping countries to set prescribing and dispensing rules
and ensuring compliance with these rules, says Ruairi Bruagh.

Work should start with doctors, nurses and trained pharmacists ? governments could use
NGOs to monitor private providers, although projects that work with the unorganised
individual providers are likely to be highly labour intensive.

National treatment policies need to take account of the coverage achieved by particular
types of providers and the population profile they serve. In small towns with large rural
catchment areas, private prescribers may be the only medical practitioners available.

Source:http://www.aidsmap.com/news/newsdisplay2.asp?newsId=2127 24 June, 2003).
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