Utilization Trends of Antiviral and Antifungal Agents for Human Systemic Use in Tanzania From 2010 to 2017 Using the World Health Organization Collaborating Centre for Drug Statistics Methodology

Abstract

IntroductionThe increase in antimicrobial consumption contributes to the emergence of antimicrobial resistance (AMR). Many studies have investigated the patterns of antibacterial consumption and antibacterial resistance. However, there is a paucity of data on the utilization of antivirals and antifungals in low and middle-income countries to serve as a baseline for monitoring and surveillance of AMR. Therefore, this study determined Tanzania’s systemic antifungal and antiviral utilization trends from 2010 to 2017, based on the Tanzania Medicines and Medical Devices Authority (TMDA) medicine importation archives.MethodologyAn analytical, longitudinal retrospective survey covering 2010 to 2017 was conducted. The study utilized the Anatomical Therapeutic and Chemical (ATC) classification and Defined Daily Dose (DDD) developed by the World Health Organization (WHO) Collaborating Centre for Drug Statistics and the WHO Collaboration Centre for International Drug Consumption Monitoring. Human medicine importation data were collected from TMDA headquarters and used to assess the systemic antiviral and antifungal consumption trends. The importation data included the date, generic name, strength, brand name, currency, quantity, ATC classification, supplier country, port of entry and product supplier. The data were cleaned, reorganized and analyzed. Reference was made to the latest revised DDD list to assign antifungals and antivirals to their respective ATC/DDDs and then adjusted to the population estimates from the National Bureau of Statistics of Tanzania.ResultsThere was a high proportion of systemic antivirals and antifungals utilization with 367.1 and 10.8 DDD per 1000 inhabitants per day (DID) respectively over eight years. In regression model, there was a significant increase in both antiviral (p-value = 0.043) and antifungal (p-value = 0.015) agents’ utilization trends in Tanzania in the study period. Fluconazole had the highest proportion of utilization for antifungals, followed by ketoconazole, itraconazole, miconazole and amphotericin B. For systemic antivirals, a high proportion was attributed to antiretrovirals used for HIV infections.ConclusionFindings from this study suggest an increase in the utilization of systemic antiviral and antifungal agents. These findings may be used to further benchmark utilization and AMR studies in Tanzania.