USAID's Key Achievements
Providing Guidance to Global
Fund Countries.
An enormous proportion of
Global Fund
resources will be for procurement of essential
HIV/AIDS, TB, and malaria drugs. To contain
drug resistance, recipient countries must be
concerned with building systems to manage
and use these drugs appropriately and with
monitoring the emergence of drug resistance.
USAID’s Bureau for Global Health has
helped
WHO develop comprehensive guidance for
countries receiving Fund support to be published
in 2004.
Tracking Resistance Patterns. Better information
is needed on the epidemiology of
vaccine-preventable bacterial infections, particularly
those caused by S. pneumoniae and
H. influenzae, which are leading agents of
mortality among children in developing countries.
From 1993 to 2003 in India, the Indian
Clinical Epidemiology Network tracked patterns
of antimicrobial resistance and serotype
distributions of these isolates in six hospital
surveillance sites across the country. The
resulting information has provided the Indian
government and neighboring countries with
good evidence of high levels of resistance
to
cotrimoxazole in pneumococcal and H.
influenzae infections. This evidence has influenced
the management of patients, particularly
children who have meningitis, pneumonia, or
septicemia. Information on serotype distributions
will be important in designing future
vaccine programs to reduce acute respiratory
infections and meningitis in children.
Improving Treatment Regiments.
In the
Philippines, USAID partners are supporting
an
initiative to promote “rapid-cycle quality
improvement for infection control.” Treatment
guidelines, a structured approval process,
provider education, standardized admitting
forms, and an audit process are being fieldtested
in Manila. In one hospital, use of the
correct antimicrobial regimen for surgical
prophylaxis
increased from 50 to 89 percent of
patients. Discussions have been initiated with
the Philippines Department of Health about
disseminating these infection control methods
to other hospitals.
Identifying Drug Resistance. Improper
prescribing by pharmacists, self-prescribing
by
individuals, and counterfeit or poor-quality
medications contribute to malaria drug resistance
in Cambodia. In an effort to improve
prescription practices and ensure that effective
medications reach consumers, USAID supported
two research studies to determine the extent
of poor medication practices. The studies
found that only 11 percent of people with
symptoms of malaria received the nationally
recommended first-line therapy; that 41 percent
of people receiving treatment for malaria
did not take the full course of medication;
and
that 50 percent were self-prescribing with
medications obtained in the private market.
In
addition, many malaria drugs for sale were
of
poor quality and not registered in the country.
The research results have been shared with
neighboring countries to warn them of these
poor-quality products.
Advocacy on Global
Initiatives.
USAID continued its advocacy in support of strategies for
minimizing the development and spread of drug resistance. This is especially critical as
new initiatives such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria begin to
supply large amounts of pharmaceuticals to countries that may not have systems to manage
and use them appropriately. USAID's advocacy and technical assistance has helped ensure that
Global Fund proposals reflect the importance of containing antimicrobial resistance and
assessing the capacity of health systems to manage pharmaceuticals.
Improving Use of Medicines.
Through support to the Joint Research Initiative for Improving
the Use of Medicines, USAID has been building research capacity around the globe to discover
effective interventions for improving drug use by consumers and drug prescribing and dispensing by health providers. Research has demonstrated that targeted, behaviorally focused interventions can achieve large impacts on prescribing practices. A study involving Vietnamese district hospital physicians brought about an
increase in appropriate prescribing for acute respiratory infections (ARI) from 35 to 57 percent
and a one-third reduction in unnecessary prescribing for non-ARI conditions.
Latin America and Caribbean Antimicrobial
Resistance Initiative.
This initiative is introducing approaches to improving antimicrobial drug
use in nine countries in Latin America and the Caribbean. It is also providing training and reference materials to improve laboratory capacity for monitoring antimicrobial resistance. As of
2002, seven countries had established national networks to monitor antimicrobial resistance,
with six of them already achieving the laboratory quality control target of 95 percent. Regional
treatment guidelines to promote rational use of antibiotics were launched in 2002, and national
adaptation activities are ongoing.
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