Management Asthma Drug Facility · Asthma Drug Facility, The Union. Essentials of Asthma Care For...
Transcript of Management Asthma Drug Facility · Asthma Drug Facility, The Union. Essentials of Asthma Care For...
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Management
Asthma Drug Facility
Prof Nadia Aït-Khaled, representative of Working Group 4
Karen Bissell, DrPH, representative of Asthma Drug Facility, The Union
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Essentials of Asthma CareFor low- and middle-income countries
• Objective: quality and cost-effective asthma care
for the majority of asthma patients
• Good essential practice from GINA guidelines
• Organisation of care in general services
• Standardised diagnosis with simple tools
• Standardised treatment with essential drugs
• Evaluation to assure quality of care
Ait-Khaled N, Enarson D. Guide 1996, revised in 2005
Ait-Khaled N et al. Workshop report. Int J Tuberc Lung Dis 2001; 5(10):973-7.
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Efficiency of The Union model Routine cohort analysis after 1 year*
100310TOTAL
1135Failure
13Transfer
35116Default
2061Control
3195Success
Per centPer centNumberNumberOutcomeOutcome
* Outcome after one year in Algeria, Morocco, Syria and Vietnam
Aït-Khaled N et al. Int J Tuberc Lung Dis. 2006 ;10(8):911-6.
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Results under routine conditions*Evaluation of quality of care
0
20
40
60
80
100
120
140
160
Before After
ER visits
Hospitalization
* Outcome after one year: Union guide in Algeria, Morocco, Syria and Vietnam
Nb events
N=126
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Main challenges for asthma care
Comprehensive approach for lung health*
• Lack of political commitment: priority in infectious diseases, no national guidelines
• Lack of organisation of services: patients treated only for attacks
• Diagnosis based only on symptoms, lung function not available
• No standardised long term treatment and use of inadequate oral drugs or ineffective drugs such as antibiotics and mucolytics
• Inhaled steroids not affordable for the majority of patients
* Implemented in several sites of Sudan, China and Benin, 2006-2007
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Why create an Asthma Drug Facility?
The Union created the ADF
• to provide access for low and middle-
income countries to affordable good quality
essential asthma medicines
• to promote standardised management of
asthma with evaluation of quality of care
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How does the ADF work?
• ADF organises qualification of manufacturers and
products (as part of its Quality Assurance system)
• Countries purchase generics at affordable prices; ADF
provides training materials and EpiData information
system.
Additional services in collaboration with The Union:
• Training courses and technical assistance
ADF requirements:
• implement The Union’s standardised 4 step approach (or
local adaptation) and report on outcomes of persistent
asthma cases treated with drugs purchased through ADF
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Qualification of manufacturers
and their products• 4 manufacturers submitted Expressions of Interest
for HFA inhaled steroids and short-acting beta
agonists
• Panel examining submissions (incl. 2 pharmacists)
Next steps
• site visits: to evaluate site and products
• list of qualified manufacturers & qualified products
• limited international tender
• publish prices and receive orders (Oct 2008)
ADF in 2008
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Assuring quality
ADF will work to:
• ensure that quality of drugs is never compromised in the search for low prices
• ensure that standardised management is understood to be key for evaluating quality
• promote use of CFC-free drugs
• promote rational and accountable drug purchasing and distribution by national and international actors
ADF in 2008
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Orders and collaboration with countries
• ADF and The Union will envisage regional and/or national training courses and technical assistance, if funds are available
• ADF will work with countries towards optimal conditions for delivery of drugs and monitoring of outcomes
• Countries need to have budget and political
commitment for asthma
ADF in 2008
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Role of Practical Approach to Lung health
• PAL included in the Stop TB Partnership’sstrategic plan 2006-2015: at least 50% of countries must have implemented PAL before2015
• Number of countries adopting PAL is increasing each year. Governments are committing to purchasing asthma drugs
• Growing number of countries are receiving budget for PAL through GFATM; some have obtained budget for purchasing asthma drugs
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Role of GARD
GARD will play a decisive role in obtaining
commitment from low-income country
governments by encouraging them to:
• identify asthma as a new public health priority
• allocate a budget line for the purchase of
essential asthma medicines
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Addressing challenges for organisation
of services for CDR management
Implementation of complementary strategies for the integrated management for tuberculosis and other respiratory diseases according to the country priorities:
• Practical Approach to Lung Health (WHO): syndromic approach at the level of primary health care
• and Comprehensive Approach to Lung Health (CLH) implemented by The Union at the first referral level
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Asthma Drug Facility and GARD partners
Improving the management of asthma patients
in low and middle income countries