Gender and treatment for HIV/AIDS, tuberculosis, and malaria in low and middle-income countries: A systematic review
João L. Carapinha, Dennis Ross-Degnan, Paul Ashigbie, Catherine Vialle-Valentin, Anita K. Wagner
PubMed Search Terms
#1 Medicines
((“drugs, generic” or “prescriptions, drug” or (pharmaceutical preparations) or drug utilization or pharmacoepidemiology or pharmacoeconomic* or prescribing[ti] or medicines[ti] or self-medication[ti] or self medication[ti] or “drug safety”[ti] or prescription fees or drugs, non-prescription or drug costs or drug information service[ti] or antibiotic or antiretroviral or ARV or antimicrobial or antimalarial or anti-malarial or “rational drug use” or (rational use[tw] and (medicine[tw] or medicines[tw] or drug[tw] or pharmaceutical[tw] or medication[tw]))) NOT (ah[sh] or ai[sh] or bi[sh] or bl[sh] or bs[sh] or cf[sh] or cs[sh] or ch[sh] or ci[sh] or cy[sh] or em[sh] or en[sh] or im[sh] or ir[sh] or ip[sh] or me[sh] or re[sh] or se[sh] or ul[sh] or ur[sh] or us[sh] or ve[sh]))
#2 Medicines Policies and Systems
(((Drug utilization and guideline adherence) or (pharmaceutical*[ti] and (advertising[ti] or promotion[ti] or marketing[ti])) or pharmaceutical care[ti] or dispensing[ti] or prescri*[ti] or formulary[ti] or formularies or “medication use”[ti] or (“drug use”[ti] not (narcotic or alcohol or illicit or drug abuse or substance-related disorders[mh]))) and (((policy[ti] or policies[ti]) not narcotic) or implement*[ti] or dissem*[ti] or improv*[ti] or chang*[ti] or interven*[ti] or optim*[ti] or influenc*[ti] or impact*[ti] or effect*[ti] or reduc*[ti] or increas*[ti] or modify*[ti] or adherence[ti] or nonadherence[ti] or “before and after”[ti])) or (attitude of health personnel and prescriptions, drug) or ((“persuasive communication” or “educational outreach”) and (“prescribing” or prescriber* or prescription* or pharmaci* or pharmac* or pharmaceutic*)) or (“academic detailing” or “drug detailing” or “counterdetailing” or “counter-detailing” or “detailers”) or (“educational outreach” and (prescribing or prescription*)) or (“drug donation” or “drug donations” or “pharmaceutical management”[tw] or “drug procurement” or “pharmaceutical procurement”) or (drug fund[tw] or ((drug[tw] or medicine[tw]) and revolving fund*) or (“bamako initiative”)) or ((“medicines policy”[ti] or “pharmaceutical policy”[ti] or “drug policy”[ti]) not (addict* or narcotic)) or (essential medicines[ti] or essential drugs[ti] or preferred drug[ti] or pharmaceutical benefits[ti] or pharmaceutical policy[ti]) or (“prescribing indicators”[ti]) or (rational drug use[ti] or “rational pharmacotherapy”[ti] or “medicine taking”[ti] or “dispensing errors”[ti] or “prescribing errors”[ti] or “generic substitution”[ti] or “pharmacy intervention”[ti] or “injection safety” or “injection use” or ((rational use[ti] or irrational use[ti] or appropriate use[ti] or inappropriate use[ti]) and (drugs [ti] or medicines[ti]))) or ((antibiotic use[ti] or antimicrobial use[ti] or antibiotic utilization[ti] or antimicrobial utilization[ti] or antibiotic utilisation[ti] or (malaria*[ti] and drug*[ti] and (use[ti] or utilization[ti] or utilization[ti]))) and ((reduc*[ti] or improv*[ti] or interven*[ti] or optimiz*[ti] or changing[ti] or changes[ti]) or intervention)) or ((antibiotic or antimicrobial or malaria or tuberculosis) and (intervention or controlled trial) and ((prescribing[ti] or reduc*[ti] or improv*[ti] or interven*[ti] or optimi*[ti] or chang*[ti] or guideline*[ti] or effectiveness[ti]) and (clinical guideline or prescribing or quality of care or drug utilization or compliance or adherence or professional competence) or education))
#1 OR #2 to create subset #3, i.e. all research related to medicines with an explicit inclusion of “antibiotic or antiretroviral or ARV or antimicrobial or antimalarial or anti-malarial” as a way to include medicines related to HIV/AIDS, TB, and malaria.
#4 Action Titles
((disseminat*[ti] or implement*[ti] or evaluat*[ti] or influenc*[ti] or adherence[ti] or nonadherence[ti] or compliance[ti]) and (guideline[ti] or guidelines[ti] or innova* [ti] or improv*[ti])) or ((efficac*[ti] or assess*[ti] or result[ti] or results[ti] or impact[ti] or impacts[ti] or impacting[ti] or effect*[ti] or evaluat*[ti] or measur*[ti] or fail*[ti]) and (intervention[ti] or interventions[ti] or policy[ti] or policies[ti] or program*[ti] or guideline[ti] or guidelines[ti] or experiment[ti] or experiments[ti] or experimental[ti] or practice*[ti])) or ((decrease[ti] or decreases[ti] or decreasing[ti] or reduce[ti] or reduc*[ti] or increase[ti] or increasing[ti] or controlling[ti] or facilitat*[ti] or shift[ti] or collaborat*[ti]) and (error[ti] or errors[ti] or irrational[ti] or inappropriate[ti])) or ((monitoring[ti] or auditing[ti] or “audit and feedback”[ti] or changing[ti] or chang*[ti] or improv*[ti] or increas*[ti] or optimi*[ti]) and (use[ti] or knowledge[ti] or practice[ti] or practices[ti] or behavior[ti] or behav*[ti] or compliance[ti] or comply[ti] or non compliance[ti] or adherence[ti] or nonadherence[ti] or management[ti] or treatment[ti] or safety[ti] or quality[ti] or implement*[ti])) or self-medication[ti] or health seeking[ti]
#3 AND #4 to create subset #5, i.e. all medicines research that point to interventions and thus empirical research (experimental and quasi-experimental (cohort studies, case-control studies, etc.)
#6 Specific Disease Areas – HIV/AIDS, TB, and malaria
(*malaria*[ti] or tuberculosis[ti] or TB[ti] or HIV[ti] or human immunodeficiency virus[ti] or *malaria* or tuberculosis or TB or HIV or human immunodeficiency virus)
#5 AND #6 to create subset #7, i.e. all medicines research that point to intervention research about HIV/AIDS, TB and malaria studies. This subset contains abstracts with and without gender explicitly mentioned in the abstract.
#8 Gender
(men[MeSH Terms] OR women[MeSH Terms]) OR gender OR sex[MeSH Terms] OR sex factors[MeSH Terms] OR sex characteristics[MeSH Terms] OR sex differences OR men OR man OR male OR women OR woman OR female OR sex OR sex factors OR sex characteristics
#5 AND #6 AND #7 to create subset #9, i.e. all medicines research that point to intervention research constrained to HIV/AIDS, TB and malaria studies that include a gender dimension.
#10 Exclusions
historical article[pt] or editorial[pt] or news[pt] or letter[pt] or comment[pt] or biography[pt] or festschrift[pt] or interview[pt] or letter[pt] or news[ti] or biography[ti] or newspaper article[pt] or opinion[ti] or in vitro or tolerability or outbreak or pathogenesis or etiology or aetiology or neutropenia or antineoplastic or single-blind or double-blind or drug evaluation or therapeutic equivalency or bioequivalence or synthesis or cell or plant or transplant or clone or immunology or microbiology or metabolism or pharmacokinetics or toxicity or biosynthesis or chemistry or pharmacognosy or biotechnology or cytology or embryology or genetics or bacteremia or neutropenia or vaccination or congenital or genetic or neutrophils or phagocytosis or susceptibility or drugs, Chinese or illicit or methadone or heroin or narcotic or “anatomy and histology”[sh] or “animals”[mh] or radio*[mh]
#9 NOT #10 to create subset #11, i.e. excluding material that relates to interventions not of interest such as clinical trials, animal and plant studies, and excluding material not considered empirical research such as newspapers, letter to the editor, editorial, etc. This is performed on search #7 that contains articles with and without gender explicitly mentioned in the abstract.
#12 Developing Countries
Afghanistan OR Albania OR Algeria OR Andorra OR Angola OR Antigua and Barbuda OR Argentina OR Armenia OR Aruba OR Azerbaijan OR Bahrain OR Bangladesh OR Barbados OR Belarus OR Belize OR Benin OR Bhutan OR Bolivia OR Bosnia and Herzegovina OR Botswana OR Brazil OR Bulgaria OR Burkina Faso OR Burundi OR Cambodia OR Cameroon OR Cape Verde OR Cayman Islands OR Central African Republic OR Chad OR Chile OR China OR Colombia OR Comoros OR Congo, Dem. Rep. OR Congo, Rep. OR Costa Rica OR Côte d’Ivoire OR Croatia OR Cuba OR Czech Republic OR Djibouti OR Dominica OR Dominican Republic OR Ecuador OR Egypt OR El Salvador OR Equatorial Guinea OR Eritrea OR Estonia OR Ethiopia OR Fiji OR Gabon OR Gambia OR Georgia OR Ghana OR Gibraltar OR Greece OR Grenada OR Guatemala OR Guinea OR Guinea-Bissau OR Guyana OR Haiti OR Honduras OR Hungary OR India OR Indonesia OR Iran OR Iraq OR Jamaica OR Jordan OR Kazakhstan OR Kenya OR Kiribati OR Korea OR Kosovo OR Kyrgyz Republic OR Lao PDR OR Latvia OR Lebanon OR Lesotho OR Liberia OR Libya OR Lithuania OR Macao OR Macedonia OR Madagascar OR Malawi OR Malaysia OR Maldives OR Mali OR Malta OR Marshall Islands OR Mauritania OR Mauritius OR Mayotte OR Mexico OR Micronesia OR Moldova OR Mongolia OR Montenegro OR Morocco OR Mozambique OR Myanmar OR Namibia OR Nepal OR Netherlands Antilles OR New Caledonia OR Nicaragua OR Niger OR Nigeria OR Northern Mariana Islands OR Oman OR Pakistan OR Palau OR Panama OR Papua New Guinea OR Paraguay OR Peru OR Philippines OR Poland OR Puerto Rico OR Romania OR Russia OR Rwanda OR Samoa OR San Marino OR São Tomé and Principe OR Saudi Arabia OR Senegal OR Serbia OR Seychelles OR Sierra Leone OR Slovak Republic OR Slovenia OR Solomon Islands OR Somalia OR South Africa OR Sri Lanka OR St. Kitts and Nevis OR St. Lucia OR St. Vincent and the Grenadines OR Sudan OR Suriname OR Swaziland OR Syrian Arab Republic OR Tajikistan OR Tanzania OR Thailand OR Timor-Leste OR Togo OR Tonga OR Trinidad and Tobago OR Tunisia OR Turkey OR Turkmenistan OR Tuvalu OR Uganda OR Ukraine OR Uruguay OR Uzbekistan OR Vanuatu OR Venezuela OR Vietnam OR West Bank and Gaza OR Yemen OR Zambia OR Zimbabwe
#11 AND #12 to create subset #13, i.e. all medicines research in low and middle-income countries that point to intervention research constrained to HIV/AIDS, TB and malaria studies including all gender specific articles.
Analogous search terms were used for JStor, ISI Web of Science, the International Network for the Rational Use of Drugs (INRUD) Bibliography, the disease-specific INRUD ART Adherence Bibliography, and the WHO Database on Medicines Use in Primary Care in Developing and Transitional Countries.
The book ‘What You Should Know About Generic Medicine?’ is published to debunk the myth that generic drugs are of lower quality as compared to branded drugs. Programme Chairman for the USM’s Discipline of Social and Administrative Pharmacy and also editorial chairman, Associate Prof. Mohamed Azmi Ahmad Hassali said generic medicines should be safe and as efficacious as branded or innovator product. Director of USM Press, Profesor Dato’ Dr. Md. Salleh Yaapar who was also present at the ceremony said this book will help patients as well as heath practitioners to educate the public on the flawed perception of generic drugs. Dean School of Pharmaceutical Sciences (PPSF), Prof Madya Syed Azhar Syed Sulaiman said this book has a very significant role to educate the public on this issue. The book will be on sale at the USM co-operative bookshop and MPH Bookstores at RM 10 (USD 3.50) per copy. Order Form.
João L. Carapinha, Brook K. Baker
The spice trade of antiquity and contemporary medicine trade appear to share much in common.
For centuries, Greeks and Romans traded spice with Asia using trade routes over land and sea to India and China. They were the Indian-Roman routes and Incense routes with paths crossing the Red Sea and Asia Minor – the same routes that Marco Polo used and later detailed in his book The Travels of Marco Polo. When the Ottomans defeated the Byzantine Empire in 1453, all spice trade between Asia and Europe ceased because Europeans refused to pay exorbitant taxes on goods traveling west through the Ottoman Empire. Europeans were left with no option but to explore alternative trade routes to the east. In 1497, Vasco da Gama, the great Portuguese explorer and navigator, pioneered a Portuguese trade route that connected Lisbon to India around the tip of South Africa, and thus started the Age of Discovery. Much of his work was built on the efforts of Bartholomeu Dias, another Portuguese navigator, who nine years prior rounded the Cape of Good Hope, currently Cape Town.
In 2008 and 2009, customs officials in the Netherlands, Germany, and France seized nearly 20 shipments of unpatented generic medicines lawfully produced in India that were being transshipped through Europe on their way to Africa, Latin America, and other destinations where they could be lawfully imported and consumed without violating any domestic patent rights. What was the problem according to complaining Big Pharma companies and border officials – transshipment violated fictional patent rules that provided that the medicines should be treated as if they had been manufactured in Europe. In one instance there was confusion about an alleged trademark infringement for a medicine that merely was labeled with the international non-proprietary name. Indian, Brazil and access-to-medicines activists complained bitterly and Brazil and India brought separate complaints at the World Trade Organization challenging the seizures and the law (EU Border Measures Regulation 1383/2003) upon which they were based. The European Court of Justice has since clarified that goods shouldn’t be seized unless they are intended for the European market and the EU is discussing a proposed amendment to its border regulations to the same effect. However, the current debate overlooks a much bigger question that history can help answer. India, why do you continue to rely on European trade routes for medicine exportation to low- and middle-income (LMI) countries?
It seems odd from a geographical perspective that medicines bound for Sub-Saharan Africa, for example, should transit through Europe. If alternative, efficient trade routes were established and expanded, will it negate the need for much of the debate on EU odious border regulation? Alleged patent and trademark infringements may become superfluous when medicines are not routed through Europe. Like Europe after 1453 that refused to pay high taxes on goods resulting in Portuguese-led alternative trade routes, perhaps India should do the same. Follow the preliminary lead of some India producers who have already changed their routes, cut all medicine trade through Europe and look to new trade routes that connect generic medicine producers in India directly to the poor in Sub-Saharan Africa. There are many risks and the costs of doing so are probably high, but so was the Age of Discovery – a treacherous and time-consuming path to India around Africa compared to those through the Ottoman Empire. It brought Europe out of the Middle Ages and it may open a new age for India’s development and South-South trade more broadly. Medicine prices may increase in the short-term but it is a price worth paying to secure favorable trade routes in the long-term. Better direct trade-route partnerships between India and LMI countries are needed. Infrastructure improvement at ports (air and sea), tax exemption on all medicine trade between partner countries, and an independent agency to certify medicine authenticity and to expedite product registration may be among the tools used to optimize direct and improved trade in medicines.
Ancient spice trade and current medicine trade share much in common. History has taught us that if trade routes become unfavorable because of geopolitical changes, then it may be time to look to alternatives. It has also taught us that the risks are high but the benefits overshadow these when assessed retrospectively. India, why do you continue to rely on European trade routes for medicine exportation to low and middle-income (LMI) countries? Do what the Europeans did after 1453; you will not regret it in the long-term.
The second poster concerns Health Insurance Systems in Five Sub-Saharan African Countries.
We found:
- There is a lack of comprehensive information on medicines benefits in Sub-Saharan Africa
- There are challenges with providing effective and efficient medicines benefits
- Fraud is a serious issue which requires improved record management systems and provider/member education
- Questions about the design, implementation, and outcomes of medicines benefit policies remain unanswered
- Questions about the impacts of corporate status, revenue sources, structural relationships with health care facilities and dispensaries, and membership profiles remain unanswered
Download a copy of the abstract and poster 213Poster
