Challenges and issues in drug utilization research identified from the Latin American and African regions

Salas, Maribel and Lopes, Luciane C and Godman, Brian and Truter, Ilse and Hartzema, Abraham G and Fadare, Joseph and Burger, Johanita and Appenteng, Kwame and Donneyong, Macarius and Arias, Ariel and Ankrah, Daniel and Ogunleye, Olayinka O and Galicia, Diana Gomez and Garcia Estrada, Miriam del Carmen and Oluka, Margaret N and Massele, Amos and Alesso, Luis and Herrera Comoglio, Raquel and Bernet, Jorgelina and Vilaseca, Carmen and Lubbe, Martie S and Horne, Laura and Bergman, Ulf (2018) Challenges and issues in drug utilization research identified from the Latin American and African regions. In: 34th International Conference on Pharmacoepidemiology and Therapeutic Risk Management 2018, 2018-08-22 - 2018-08-26, Prague Congress Centre.

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Background: Despite advancements in drug utilization research (DUR), these have not been universal. Some regions such as the Latin America (LatAm) and African regions are facing challenges that are impeding the development of DUR. Objectives: To identify the main challenges and issues for DUR in the LatAm and African regions Methods: A collaborative initiative by the International Society of Pharmacoepidemiology Global Development Committee in partnership with the Latin America Drug Utilization Group and the Medicines Utilization Research in Africa Group was undertaken. A comprehensive literature review was conducted to identify local and international DUR publications. A core group of investigators and experts in DUR reviewed the publications and identified the main methodological challenges and issues. Subsequently, the group exchanged materials, participated in WebEx discussions, and reviewed the draft document. Results: Main issues: 1) Socioeconomic: high unemployment rate with poor standard of living, socioeconomic inequalities, low literacy levels, urban segregation, high migration rates, high rates of violent crime including drug trafficking and possession. 2) Healthcare-related: Disparities of social determinants of health, differences in the quality of public and private health sectors; and epidemiologic transition from communicable diseases to non-communicable diseases. Most health care systems are fragmented with variable access to medical care and medicines, and substandard record keeping. 3) Drug utilization-related: Inappropriate use of medicines including the elderly; limited infrastructure to reliably collect DU data; over-prescription of antimicrobials; polypharmacy; high rates of self-medication; and poor patient adherence (e.g. HIV/AIDS, diabetes mellitus and hypertension). Planning for DUR is affected by the multiplicity of drug distribution channels; trading in sub-standard, counterfeit medicines and insufficient quality control centers. Some publications are generated by local investigators, often suffering of methodological issues such as lack of representativeness of the population, limited data validity, and small sample sizes. Conclusions: There are common challenges for DUR when working within the LatAm and African regions. Based on our findings, the group is developing Guidance on Good Practices of Drug Utilization Research in those regions to assist researchers with issues pertaining to the planning, conduct, and evaluation of DUR.