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Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries

Stolbrink M 1 , Chinouya MJ 2 , Jayasooriya S 3 , Nightingale R 4 , Evans-Hill L 5 , Allan K 6 Show all authors , Allen H 7 , Balen J 8 , Beacon T 9 , Bissell K 10 , Chakaya J 11 , Chiang CY 12 , Cohen M 13 , Devereux G 14 , El Sony A 15 , Halpin DMG 16 , Hurst JR 17 , Kiprop C 18 , Lawson A 19 , Macé C 20 , Makhanu A 18 , Makokha P 18 , Masekela R 21 , Meme H 22 , Khoo EM 23 , Nantanda R 24 , Pasternak S 25 , Perrin C 20 , Reddel H 26 , Rylance S 27 , Schweikert P 19 , Were C 25 , Williams S 28 , Winders T 29 , Yorgancioglu A 30 , Marks GB 31 , Mortimer K 32

Affiliations 

  • 1 Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Stellenbosch University, Tygerberg, South Africa
  • 2 Education Department, Liverpool School of Tropical Medicine, Liverpool, UK
  • 3 Academic Unit of Primary Care, University of Sheffield, Sheffield, UK
  • 4 Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, IcFEM Dreamland Mission Hospital, Kimilili, Kenya
  • 5 Nifty Fox Creative, Sheffield, UK
  • 6 Healthcare Consultant, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, The Gambia
  • 7 Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, The Gambia
  • 8 School of Health and Related Research, University of Sheffield, Sheffield, UK
  • 9 Medical Aid International, Bedford, UK
  • 10 School of Population Health, University of Auckland, Auckland, New Zealand
  • 11 Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya
  • 12 International Union Against Tuberculosis and Lung Disease, Paris, France, Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  • 13 Asociación Latinoamericana del Tórax, Forum of International Respiratory Societies, Guatemala
  • 14 Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  • 15 The Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum Sudan
  • 16 University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
  • 17 UCL Respiratory, University College London, London, UK
  • 18 IcFEM Dreamland Mission Hospital, Kimilili, Kenya
  • 19 AstraZeneca, Cambridge, UK
  • 20 International Union Against Tuberculosis and Lung Disease, Paris, France
  • 21 Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
  • 22 Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
  • 23 Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Larbert, Scotland, UK
  • 24 Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
  • 25 GlaxoSmithKline, Brentford, UK
  • 26 The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia, Global Initiative for Asthma (GINA), Fontana, WI, USA
  • 27 Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland
  • 28 International Primary Care Respiratory Group, Larbert, Scotland, UK
  • 29 Global Allergy & Airways Patient Platform, Vienna, Austria
  • 30 Department of Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey, Global Alliance Against Chronic Respiratory Diseases, Geneva, Switzerland
  • 31 International Union Against Tuberculosis and Lung Disease, Paris, France, University of New South Wales, Sydney, NSW, Australia
  • 32 International Union Against Tuberculosis and Lung Disease, Paris, France, University of Cambridge, Cambridge, UK
Int J Tuberc Lung Dis, 2022 Nov 01;26(11):1023-1032.
PMID: 36281039 DOI: 10.5588/ijtld.22.0270

Abstract

BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022.METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis.RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs; 2) limited data on CRD burden and treatments in LMICs; 3) ineffective procurement and distribution networks; and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice; 2) capacity building; 3) improved procurement mechanisms; 4) strengthened advocacy practices; and 5) a World Health Assembly Resolution.CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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