Amir Shroufi1, Nelesh P Govender2, Graeme Meintjes3, John Black4, Jeremy Nel5, Mahomed-Yunus S Moosa6, Colin Menezes7, Halima Dawood6, Douglas Wilson8, Laura Trivino Duran1, Olawale Ajose9, Richard A Murphy10, Thomas Harrison11, Angela Loyse12, Carol Ruffell13, Gilles Van Cutsem14. 1. Doctors Without Borders South Africa, Johannesburg, South Africa. 2. National Institute for Communicable Diseases, A Division of the National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa. 3. University of Cape Town, Western Cape, South Africa. 4. Livingstone Hospital, Eastern Cape, South Africa. 5. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 6. University of Kwa Zulu Natal, Kwa Zulu Natal, South Africa. 7. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Chris Hani Baragwanath Hospital, Johannesburg, South Africa. 8. Edendale Hospital, Kwa Zulu Natal, South Africa. 9. Drugs for Neglected Diseases Initiative, Los Angeles, USA. 10. David Geffen School of Medicine at UCLA, Los Angeles, USA; The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, USA. 11. Centre for Global Health, Institute of Infection and Immunity, St George's University of London, London, UK; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. 12. Department of Infection and Immunity, St George's University of London, London, UK. 13. Drugs for Neglected Diseases Initiative, Los Angeles, USA; Global Antibiotic Research and Development Partnership (GARDP), Cape Town, South Africa. 14. Doctors Without Borders South Africa, Johannesburg, South Africa; Centre for Infectious Disease and Research, University of Cape Town, Cape Town, South Africa.
Abstract
BACKGROUND: Cryptococcal meningitis (CM) is estimated to cause 181 000 deaths annually, with the majority occurring in Sub-Saharan Africa. Flucytosine is recommended by the World Health Organization as part of the treatment for CM. Widespread use of flucytosine could reduce mortality in hospital by as much as 40% compared to the standard of care, yet due to market failure, quality-assured flucytosine remains unregistered and largely inaccessible throughout Africa. METHODS: The recently established South African flucytosine clinical access programme is an attempt to address the market failure that led to a lack of public sector access to flucytosine for CM, by making the medicine freely available to tertiary hospitals in South Africa. RESULTS: Between November 2018 and September 2019, 327 CM patients received flucytosine through this programme, with efforts to support sustainable national scale-up presently ongoing. We describe why this programme was needed, its catalytic potential, what is still required to ensure widespread access to flucytosine, and observations from this experience that may have wider relevance. CONCLUSIONS: The South African flucytosine access programme illustrates how access programmes may be one part of the solution to addressing the vicious cycle of perceived low demand, limiting manufacturer interest in specific product markets.
BACKGROUND:Cryptococcal meningitis (CM) is estimated to cause 181 000 deaths annually, with the majority occurring in Sub-Saharan Africa. Flucytosine is recommended by the World Health Organization as part of the treatment for CM. Widespread use of flucytosine could reduce mortality in hospital by as much as 40% compared to the standard of care, yet due to market failure, quality-assured flucytosine remains unregistered and largely inaccessible throughout Africa. METHODS: The recently established South African flucytosine clinical access programme is an attempt to address the market failure that led to a lack of public sector access to flucytosine for CM, by making the medicine freely available to tertiary hospitals in South Africa. RESULTS: Between November 2018 and September 2019, 327 CMpatients received flucytosine through this programme, with efforts to support sustainable national scale-up presently ongoing. We describe why this programme was needed, its catalytic potential, what is still required to ensure widespread access to flucytosine, and observations from this experience that may have wider relevance. CONCLUSIONS: The South African flucytosine access programme illustrates how access programmes may be one part of the solution to addressing the vicious cycle of perceived low demand, limiting manufacturer interest in specific product markets.
Authors: Bruce Larson; Amir Shroufi; Charles Muthoga; Rita Oladele; Radha Rajasingham; Alexander Jordan; Joseph N Jarvis; Tom M Chiller; Nelesh P Govender Journal: Wellcome Open Res Date: 2022-06-20
Authors: Amir Shroufi; Tom Chiller; Alex Jordan; David W Denning; Thomas S Harrison; Nelesh P Govender; Angela Loyse; Solange Baptiste; Radha Rajasingham; David R Boulware; Isabela Ribeiro; Joseph N Jarvis; Gilles Van Cutsem Journal: Lancet Infect Dis Date: 2020-11-30 Impact factor: 25.071