Clinical Professor, Don Downing, along with 40 UW Pharmacy students, 2 Seattle physicians, 2 additional Seattle pharmacists, and a physical therapist came together to provide global medical care in the remote village of Namanji, Nicaragua, from June 16th through June 22nd 2014. Supported by Seattle-based Global Brigades, these self-funded students and providers provided care to almost 900 patients – many of whom traveled great distances to receive basic health care.
This isn’t the first time Downing has traveled to Central America as a mentor to students interested in providing health care and medicines in resource-limited populations. In 2011, he traveled with UW pharmacy students on a brigade to Honduras. Says Downing of his travels to Central and South America, “they have provided our students with a new perspective of unmet health care needs in low resource countries in the course of providing assistance with at least some of these needs. Many of our students now come to me with newly informed ideas of how more sustainable and effective services might be realized.”
Enhancing Health Outcomes for Chronic Diseases in Resource-Limited Settings by Improving the Use of Medicines: The Role of Pharmaceutical Care
In low- and middle-income countries (LMICs), health systems have historically focused on the prevention and treatment of highly prevalent and frequently fatal acute infectious illnesses such as malaria, diarrhea, and respiratory infections. However, due to changes in health risks, LMIC are experiencing an increasing burden of chronic non-communicable diseases (NCDs) in addition to the existing problems of infectious diseases.
This publication, with contributions from Andy Stergachis and Don Downing, explains the approach used by USAID-funded SIAPS to strengthen the practice of pharmaceutical care in resource-constrained settings through building institutional and individual capacity in pharmaceutical systems and identifying appropriate roles for staff who provide medicines or medication-related services at each level.
Andy Stergachis traveled to Mumbai, India in March to emphasize the need for give a talk titled, “Active Surveillance in Pharmacovigilance” at a Drug Information Association India sponsored conference March 21-22, 2014. The conference, which focused on pharmacovigilance, was targeted to professionals in a range of disciplines from risk management and regulatory affairs, to clinical and regulatory personnel.
His talk titled, “Active Surveillance in Pharmacovigilance” Stergachis said that drugs and vaccines are reaching unprecedented numbers of people in low- and middle-income countries and that the products have tremendous potential to save lives and reduce suffering. However, many countries in which these products will be used do not have the capacity to effectively monitor their post-marketing safety. He emphasized the need for active surveillance.
Five reasons for active surveillance:
- Enables follow-up on safety signals;
- Allows for investigation of newer products that have a limited real-world safety profile;
- Provides ability to calculate rates of risk factors for adverse events;
- Can complement other pharmacovigilance methods; and
- Enables monitoring of pregnancy outcomes following any prenatal drug exposures.
View full presentation.
A new report on drug and vaccine safety in global health, co-authored by Thomas Bollyky, Senior Fellow, Council for Foreign Relations, and Andy Stergachis, is now available. Funded by the Bill and Melinda Gates Foundation, this report is the product of the Safety Surveillance Working Group, a year-long initiative to develop a practical, scalable strategy for improving drug and vaccine safety in low- and middle-income countries.
Drugs and vaccines are reaching unprecedented numbers of people in low- and middle-income countries (LMICs). These products have tremendous potential to save lives and reduce suffering, but many of the countries in which these products will be used do not have the capacity to effectively monitor their post-market safety. International initiatives have sought to address this gap, but have not attracted significant donor or industry support, or political capital and resources from LMIC governments. With new donor funding scarce in this weak global economy, substantial new resources for addressing post-market safety needs may not be forthcoming. Given limited resources and expanding post-market safety needs, a new strategy is needed. Read the full report.
The Global Medicines Program has been awarded a three-year grant from the Barr Foundation to evaluate a pharmacy assistant (PA) training program in Malawi. Joseph Babigumira will lead the study to evaluate the potential impact of the training program on morbidity and mortality due to illnesses that are the highest contributors to mortality among children under five years of age in Malawi – malaria, pneumonia, and diarrhea.
The study has four aims:
1. Determine the difference in access to ACTs, antibiotics and ORS between communities with trained PAs at the public health centers compared to communities where PAs are not deployed.
2. Estimate the potential impact of any observed increase in access to ACTs, antibiotics and ORS attributable to PA training and deployment on under-5 malaria-, pneumonia-, and diarrhea-specific mortality respectively.
3. Determine the costs associated with scaling-up such a program
4. Estimate the potential cost-effectiveness of the program
The Pharmacy Assistant training program is a three-year effort to develop and launch an innovative certificate-level program that seeks to train at least 150 Pharmacy Assistants for health facility deployment to improve pharmaceutical management in rural Malawi. VillageReach, in collaboration with the Malawi College of Health Sciences, the Malawi Ministry of Health, and the UW Global Medicines Program, is coordinating the training program. Read more about the training program here.
Andy Stergachis, along with faculty from Ukraine, conducted a 5-day training workshop titled, “Pharmacovigilance of Medicines for HIV/AIDS and Tuberculosis in Ukraine” December 9-13, 2013 in Kiev. The training workshop was developed and offered by the Ukraine National Training Center (UNTC), with support from the UW International Training and Education Center for Health (I-TECH). In addition to Stergachis, the faculty consisted of the head of infectious diseases, Gromashevskiy Institute of Epidemiology and Infectious Diseases of National Academy of Medical Sciences of Ukraine (NAMSU); the Head of the Physiology Department, Yanovsky Institute for and Pulmonology of NAMSU; and the Director of the Department of Post-Registration Surveillance, State Expert Center of Ministry of Public Health of Ukraine, which is their national pharmacovigilance center.
Attendees were teams of physicians specializing in HIV, TB or pharmacovigilance from the various regions of Ukraine.
The objectives of the workshop were:
1. Identify and clinically manage adverse drug reactions (ADRs) to medicines used for HIV/AIDS and TB and co-infections.
2. Understand the role of co-infections and associated co-morbidities, drug interactions and other risk factors in affecting treatment outcomes and assessment of such treatment outcomes.
3. Identify the different methods used for pharmacovigilance, their strengths and weaknesses, and the need for a multidisciplinary approach for effective implantation of such methods.
4. Build practical skills in the identification, proper documentation, and timely communicating of ADRs and treatment ineffectiveness for drugs used for HIV/AIDS, TB and co-infections.
UW School of Public Health faculty attended the Institute of Medicine meeting held on September 12-13, 2013 in Washington, DC. Titled “STRENGTHENING MEDICINES REGULATORY SYSTEMS ABROAD: ADAPTING MESSAGES FROM RECENT IOM CONSENSUS STUDIES FOR DISEASE CONTROL PRIORITIES, THIRD EDITION”, the meeting attendees included Dean Jamison, Professor of Global Health and Principal Investigator (not pictured) Rachel Nugent, Clinical Associate Professor of Global Health and Project Director; Ramanan Laxminarayan Center for Disease Dynamics, Economics & Policy; Public Health Foundation of India and Affiliate Professor of Global Health; and Andy Stergachis, Professor of Epidemiology and Global Health and Director, Global Medicines Program. Also attending the meeting was Margaret Hamburg, US FDA Commissioner, and Mikel Arriola, Commissioner, COFEPRIS, Mexico.
The Disease Control Priorities, Third Edition will summarize and synthesize evidence of the effectiveness of global health interventions and provide comparative economic evaluation of policies to implement those interventions. Click here to learn more about the project.