Exploring global and country-level barriers to an effective supply of leishmaniasis medicines and diagnostics in eastern Africa: a qualitative study

Abstract

ObjectivesTo understand stakeholders’ perceptions of the access barriers to quality-assured diagnostics and medicines for leishmaniasis in the high-burden region of eastern Africa, and to identify key bottlenecks to improve the supply of commodities for neglected tropical diseases.DesignDesk reviews and qualitative in-depth interview study with purposive sampling.MethodsA landscape analysis through literature and desk review was performed. Next, 29 representatives from international organisations, non-governmental agencies, national control programmes from six countries (Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) and manufacturers were interviewed between May and July 2018. Participants were selected purposively and expanded through a snowballing technique.Data analysis was aided by NVivo, applying the framework method as a part of the thematic content analysis approach.ResultsThe barriers along the visceral leishmaniasis (VL) supply chain were identified as emerging themes, grouped across supply chain activities and health systems component(s). Stakeholders expressed the perception of progress, but bottlenecks persist. VL medicines, in general, lack multisource production capacity and with small market volume, expansion of suppliers is difficult. Procurement is plagued by forecasting difficulties, complex regulatory policies and procedures, and distribution challenges. Weak communication and coordination across different levels resulted in shortages and loss of trust among different actors. Cross-cutting issues spanned from limited political and resource commitment due to low awareness and limited in-country capacity. However, study respondents were optimistic to pursue several remedies, most importantly to build bridges between supply and demand sides through continued dialogue and collaborations. Diagnostics supply has mostly been overlooked; thus, improved investment in this area is needed.ConclusionsAddressing supply barriers in eastern Africa requires consistent, specific efforts at the global and national levels, progressing from current partnerships and agreements. Priority actions include pooled procurement, improved forecast, and increased commitment and resources. Sustainability remains an elusive goal, yet to be integrated into discussions moving forward.

Validation of in-house liquid direct agglutination test antigen: the potential diagnostic test in visceral Leishimaniasis endemic areas of Northwest Ethiopia

“…The definitive diagnosis of VL has crucial importance not only because it is almost always fatal if left untreated, but also the delay in diagnosis has implications for the transmission and reduces cure rates [8,16]. Moreover, the high cost and severe side effects associated with the available chemotherapeutic options made the value for prompt and accurate diagnosis unquestionable [3,17,18]. However, the VL endemic East African countries, including Ethiopia lack sufficient capacity and resource for the purchase of diagnostic supplies, thus their control programs are donor dependent.…”

“…East Africa carries the secondhighest burden of VL in the world. This region witnessed a re-emergence of VL, which makes it an increasing public health threat [1][2][3]. In the last few decades, VL outbreaks claimed hundreds of lives in the region both in the previously endemic and nonendemic areas [4][5][6].…”

Diagnosis of neglected tropical diseases during and after the COVID-19 pandemic

“…This represents a particular challenge for NTDs, especially with high product prices, a limited number of manufacturers, and frequent stock-outs, which reduce access to RDTs and their use where needed. A practical example is the procurement of RDTs for visceral leishmaniasis, which is challenging as countries are unable to meet the minimum order quantity established by the producers, coupled with other logistical challenges [ 15 ]. RDTs to support human African trypanosomiasis elimination have also been subsidised to enable their access and use [ 16 ].…”

Access to Chagas disease treatment in the United States after the regulatory approval of benznidazole

“…The monthly average of CD patients who obtained benznidazole increased from just under 5 persons during the period in which CDC provided benznidazole [ 16 ], to 13 on average in the nine months following commercialization on May 14, 2018. Despite the observed increase, the overall number of treated persons was still small even after commercialization, compared to the large number of estimated people infected with T .…”

“…Access can be shaped by four activity streams: architecture (the organizational structure and relationships); availability (the supply components); affordability (the cost issues for various players); and adoption (demand factors and acceptance). This framework has been used, for instance, to identify access barriers to medicines for leishmaniasis in Africa [16] and to inform development of a new accessible diagnostic for soil-transmitted helminths [17].…”