Drug Supply Research Articles

Prescribing practices in opioid agonist treatment and changes in compliance to clinical dosing guidelines in British Columbia, Canada.

In British Columbia, Canada, clinical guidelines for the treatment of opioid use disorders (OUD) were updated in 2017, during a period in which the potency and composition of the illicit drug supply changed rapidly. We aimed to describe changes in opioid agonist treatment (OAT) prescribing practices at the population level in a setting in which fentanyl and its analogs have become the primary illicit opioid of use. This was a population-based retrospective cohort study using three linked health administrative databases in British Columbia (BC), Canada. All individuals with at least one OAT dispensation in BC between 1 January 2014 and 31 August 2021 took part. To assess changes in OAT prescribing practices over time, we calculated initiation doses, dose titration intervals, maintenance doses and take-home dosing intervals stratified by medication [methadone, buprenorphine-naloxone and slow-release oral morphine (SROM)] according to recommended guidelines. A total of 265 410 OAT episodes (57.5% on methadone, 34.5% on buprenorphine-naloxone and 8.0% on SROM) were initiated during the study period. Compared with the guideline recommendation, observed initiation doses were higher among all medications from 2014 (2017 for SROM) to 2021(buprenorphine-naloxone: 14-29%; methadone: 53-66%; SROM: 26-55%). Titration intervals were shorter for all medications, consistent with guidelines for buprenorphine-naloxone (26-49%), but shorter than recommended for methadone or SROM (28-51% and 12-41%, respectively). Higher maintenance dosing was observed for methadone (68-78%) and SROM (3-21%). Take-home allowances extending beyond the recommended guideline length increased across medications (buprenorphine-naloxone: 18-35%; methadone: 50-64%; SROM: 34-39%). Changes in prescribing patterns were similar for first-time OAT initiators. In British Columbia, Canada, from 2014 to 2021, prescribers of opioid agonist treatment (OAT) appeared to initiate both new and experienced OAT clients at higher doses than guideline recommendations, titrate them more rapidly and maintain clients at higher doses. Take-home dose allowances also gradually increased.

Exploring barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public hospitals; Northeast, Ethiopia, 2023: application of socio-ecological model

BackgroundHealth literacy is the important for the prevention of non-communicable disease to make informed health decisions, and practice healthy and protective behaviours. Therefore, application of socioecological model to this study aimed to identify multilevel factors on health literacy among patients and develop scientific health communication interventional strategies to improve health literacy on non-communicable disease prevention and care.ObjectiveTo explore barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public Hospitals, Northeast Ethiopia, 2023.MethodIn this study phenomenological study design was conducted from February 5 to 30/2023.We have used purposive sampling technique to select study participants from chronic follow up clinics. Data were collected using in-depth interview and focused group discussion in which audio was recorded, transcribed verbatim and translated to English. Thematic analysis was performed with atlas ti. 7 software.ResultIn this study four main themes with seven subthemes were developed. The main themes were factors at the organizational, community, interpersonal, and intra-personal factors. The poor knowledge, lack of enough money for transportation and medication at the hospital were identified as barrier to get early diagnosis and treatment. Some participants explored that they have no any support from family or others. The cultural norms like weeding and funeral ceremonies enforce patients to consume prohibited substances like alcohol and salty foods.ConclusionIn this study different barriers of health literacy were explored. Lack of knowledge, economic problems, lack of social support, poor communication with health care providers, cultural influences, lack of regular health education, lack of access to health care services and poor infrastructure were main barriers of health literacy in patients with NCD. Therefore, we recommended all concerned bodies to work on social and behavioral change communication intervention focusing on awareness creation, supply of drugs and create supportive environment to get accessible and affordable health care service to decrease the impact of non-communicable disease at personal, community and national level.

A Dynamic Model of Opioid Overdose Deaths in Canada during the Co-Occurring Opioid Overdose Crisis and COVID-19 Pandemic.

With over 40,000 opioid-related overdose deaths between January 2016 and June 2023, the opioid-overdose crisis is a significant public health concern for Canada. The opioid crisis arose from a complex system involving prescription opioid use, the use of prescription opioids not as prescribed, and non-medical opioid use. The increasing presence of fentanyl and its analogues in the illegal drugs supply has been an important driver of the crisis. In response to the overdose crisis, governments at the municipal, provincial/territorial, and federal levels have increased actions to address opioid-related harms. At the onset of the COVID-19 pandemic, concerns emerged over how the pandemic context may impact the opioid overdose crisis. Using evidence from a number of sources, we developed a dynamic mathematical model of opioid overdose death to simulate possible trajectories of overdose deaths during the COVID-19 pandemic. This model incorporates information on prescription opioid use, opioid use not as prescribed, non-medical opioid use, the level of fentanyl in the drug supply, and a measure of the proportion deaths preventable by new interventions. The simulated scenarios provided decision makers with insight into possible trajectories of the opioid crisis in Canada during the COVID-19 pandemic, highlighting the potential of the crisis to take a turn for the worse under certain assumptions, and thus, informing planning during a period when surveillance data were not yet available. This model provides a starting point for future models, and through its development, we have identified important data and evidence gaps that need to be filled in order to inform future action.

SISTEM INFORMASI APOTEK DARUL HAYYI MENGGUNAKAN MACRO MICROSOFT EXCEL

This study aims to find out how to design and create pharmacy applications using Microsoft Excel Macros at Darul Hayyi Pharmacy. The object of this research is Darul Hayyi Samarinda Pharmacy. Data collection techniques are observation, interviews, and literature studies. The analysis tool used is the Microsoft Excel Macros program. The results of this study show that by applying Microsoft Excel Macros to the pharmacy information system, it can provide several advantages such as facilitating work or activities related to the Darul Hayyi Pharmacy Information System, such as inputting master data, inputting over-the-counter drug sales activities and drug sales with a doctor's prescription, and purchasing drug supplies. The speed and accuracy of accessing data makes it easy to create the reports needed. And by using Microsoft Excel Macros can minimize errors that usually occur if done manually

Understanding antibiotic use in the community setting in Thailand: Does communication matter?

It is known that the misuse and overuse of antimicrobials leads to antimicrobial resistance (AMR). Effective communication between dispensers and users is thus crucial in reducing inappropriate antibiotic use. This study aims to gain a better understanding of communication around the use of antibiotics in the community and seeks potential implementation strategies to change dispenser and user practices in communication aspects. Qualitative methods were employed, including in-depth interviews with 18 drug suppliers and 16 community members, and eight focus group discussions with key informants. Data were collected in the Kanchanaburi Demographic Health Surveillance System in urban and semi-urban communities in the western region of Thailand. The thematic analysis included communication quality, communication and imbalanced power, and misconceptions and instruction. The OpenCode qualitative software program was employed. The study revealed that the quality of communication was significantly influenced by the interaction of antibiotic dispensing with language and information. This interaction creates communication constraints between those dispensing antibiotics and the recipients, resulting in a less-than-optimal exchange of information. Consequently, users received limited information concerning the proper use of antibiotics. Furthermore, power imbalances and communication dynamics were perpetuated, mainly stemming from varying levels of access to and knowledge about antibiotics. This imbalance in power dynamics became evident between those dispensing antibiotics and the users. Users, as well as dispensers lacking proper qualifications, found themselves in a precarious position due to their inadequate knowledge of antibiotics. Moreover, it is noteworthy that misconceptions often conflicted with antibiotic instructions, leading to challenges in adhering to antibiotic regimens. These challenges primarily arose from misconceptions about antibiotics and concerns about potential side effects, particularly when users started to feel better. The findings highlight the importance of enhancing communication between dispensers and users through future interventions. These interventions should aim to bolster user understanding of antibiotics and provide clear, trustworthy instructions for their proper usage. Investigating innovative communication methods, such as the use of QR codes, presents a promising avenue for consideration. By addressing these communication gaps, we can advocate for the appropriate utilization of antibiotics and mitigate the prevalence of AMR.

Which Drugs Should Be on the Essential Medicines List?

The World Health Organization (WHO) published its first Essential Medicines List (EML) in 1977, and it is updated biennially. One might reasonably think drugs on the EML are there because they are critical to effective, evidence-based patient care and intervention. One might not reasonably guess, however, that a particular drug's supply chain vulnerabilities that make it a shortage risk would contribute to a drug's listing on the EML. This commentary on a case first describes why the WHO makes the EML and suggests reasons why it might be important to consider a drug's shortage risk when revising and updating it. This commentary also suggests how distinguishing "essential" drugs from "vulnerable" drugs could bolster supply chain resiliency and mitigate drug shortages' disruptions to patient care.

Public Health System's Preparedness to Address Polycystic Ovarian Syndrome: A Rapid Assessment Survey of Health-care Providers in India.

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders largely affecting women of reproductive age group. This study aimed to understand the Indian public health-care systems' preparedness in addressing PCOS. A multicentric rapid assessment cross-sectional study was undertaken among 173 health-care providers serving across various public health-care facilities in India. This study was a component of a larger task force study that aimed to estimate the community-based prevalence of PCOS in India. Information on PCOS cases reported that knowledge about PCOS diagnosis, management practices, availability of diagnostic facilities, and drugs was explored. Irregular menstrual cycle was the most commonly reported PCOS symptom. Most of the health-care providers (HCPs) lacked correct knowledge about diagnostic criteria and investigation needed for the diagnosis of PCOS. Diagnostic facilities and drugs were inadequate. However, some facilities had access to investigations through public-private partnerships. Awareness programs on PCOS in the community were negligible, and PCOS cases were not documented. Training HCPs on PCOS along with the availability of specialists and strengthening diagnostic facilities were some major demands from the HCPs. Results suggest the need for training HCPs, strengthening infrastructure with good referral linkages, and adequate supply of drugs to help improve PCOS management at public health-care facilities in India. There is a need to develop national technical and operational guidelines to address PCOS using a multidisciplinary approach across all levels of care. Creating demand for services and advocating healthy lifestyles through community awareness can help early diagnosis and prevention of complications.

Determinants of normal haemoglobin concentration among under-five children in Sub-Saharan Africa: a Positive deviance inquiry using cross-sectional study design

BackgroundLow haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin...

The domino effect of drug distribution channels on the management of chronicity.

Drug distribution channels affect all actors in the drug supply chain: healthcare institutions, healthcare professionals, patients, pharmacies, pharmaceutical companies and distributors. They should be redesigned in line with the new proximity care model planned in the Pnrr and DM 77, while avoiding a negative domino effect on the management of chronic diseases. A guide recently published by the MaCroScopio project is useful to shed light on this issue and to understand the relationship between the distribution channels present in Italy (distribuzione diretta - DD; distribuzione per conto - Dpc; distribuzione convenzionata) and the management of chronic diseases. Analysis of OsMed data showed that the majority of medicines dispensed in DD and Dpc are for chronic patients; therefore, a change in distribution channels inevitably affects chronicity management and could lead to increased expenditure. It is necessary to evaluate the transfer of drugs from one channel to another on a case-by-case basis according to the specifics of each drug. Proximity care reform requires a redesign of drug distribution channels, but this must be done with respect to the clinical, social and economic sustainability of the system.

The activities of public organizations to reduce inequality in the availability of medicines to the population. Part 2. Public organizations and their role in drug provision issues

Between 70 and 95% of medical visits end with prescribing medicines, while almost 2 billion people worldwide do not have access to essential medicines. The presented work is aimed at studying the problems of drug deficiency and the task of reducing it within the framework of the Sustainable Development Goals, as well as the research activities of public organizations on reducing socio-eco­nomic inequality and access of the population and representatives of certain groups to medicines.

РАЗРАБОТКА МЕХАНИЗМОВ ПОВЫШЕНИЯ ДОСТУПНОСТИ ЛЕКАРСТВЕННОЙ ПОМОЩИ В УСЛОВИЯХ ЧРЕЗВЫЧАЙНЫХ СИТУАЦИЙ С ИСПОЛЬЗОВАНИЕМ ГЕОИНФОРМАЦИОННЫХ ТЕХНОЛОГИЙ

The article considers the issues of availability of reserves of medicinal products intended to provide medicinal supplies to victims in the elimination of the medical and sanitary consequences of emergencies, taking into account the internal risks for territories with complex climatic and geographical characteristics. The purpose of the study was to develop approaches to increase the territorial availability of medicinal products in the Tomsk Region reserve in emergency situations. In the course of the research, content analysis of data from regulatory documents and scientific publications on the medicinal provision of the population in emergency situations was used; correlation analysis of geo-information, spatial-geographical and natural-climatic indicators characterizing the territorial availability of medicinal products. The typologization of the Tomsk region according to the degree of transport accessibility was performed using cluster analysis algorithms. It has been established that the main climatic and geographic factors creating the internal risks for the drug supply system of the disaster medicine service of the Tomsk region include dangerous hydrological phenomena, forest and peat fires, frosts and hurricanes. More than 85% of the territory of the Tomsk region belongs to hard-to-reach areas equated by climatic conditions to those of the Far North, which poses risks for the drug supply system. Based on the data of the geo-information services, the road accessibility of the Tomsk region districts in relation to the regional center has been considered, two directions «Eastern» and « Northern» have been identified including 5 and 11 respectively. It was established that direct interaction between the districts belonging to these areas bypassing the regional center is extremely difficult. In the process of typologization of the districts according to the degree of transport accessibility in the direction "East", one group with a high degree of transport accessibility between 3 districts that are remote from the regional center has been identified. Two groups of districts have been identified in the North direction. The first group, characterized by high transport accessibility, included 5 districts, including the regional center. The second group with low transport accessibility included 6 districts. The optimal area for the placement of an additional point of medicines of the Tomsk region reserve has been justified, taking into account the transport infrastructure of the districts, natural and climatic risks, socio-demographic factors and the standard time for the organization of drug provision in an emergency situation. With the use of geo-information technologies, a model of decentralization of the reserve has been developed to increase the availability of drug care by the regional disaster medicine service of the Tomsk region in the context of internal risks.

A qualitative study on perceptions and experiences of overdose among people who smoke drugs in Vancouver, British Columbia

BackgroundSmoking unregulated drugs has increased substantially in British Columbia. Intersecting with the ongoing overdose crisis, drug smoking-related overdose fatalities have correspondingly surged. However, little is known about the experiences of overdose among people who smoke drugs accessing the toxic drug supply. This study explores perceptions and experiences of overdose among people who smoke drugs. MethodsWe conducted interviews with 31 people who smoke drugs. Interviews covered a range of topics including overdose experience. Thematic analysis was used to identify themes related to participant perceptions and experiences of smoking-related overdose. ResultsSome participants perceived smoking drugs to pose lower overdose risk relative to injecting drugs. Participants reported smoking-related overdose experiences, including from underestimating the potency of drugs, the cross-contamination of stimulants with opioids, and responding to smoking-related overdose events. ConclusionsFindings highlight the impact the unpredictable, unregulated, and toxic drug supply is having on people who smoke drugs, both among people who use opioids, and among those who primarily use stimulants. Efforts to address smoking-related overdose could benefit from expanding supervised smoking sites, working with people who use drugs to disseminate accurate knowledge around smoking-related overdose risk, and offering a smokable alternative to the unpredictable drug supply.

Adulterants present in the San Diego county fentanyl supply: a laboratory analysis of seized law enforcement samples

BackgroundThe opioid overdose crisis is one of the worst public health crises ever to face the US and emerging evidence suggests its effects are compounded by the presence of drug adulterants. Here we report our efforts to characterize the adulterants present within the local fentanyl supply of San Diego County, obtained from undifferentiated drug samples seized by local law enforcement over the calendar year 2021.MethodsThirty-two participating local law enforcement agencies across San Diego submitted 4838 unknown individual illicit drug samples (total of 312 kg) to the San Diego County Sheriff’s Department Regional Crime Laboratory for identification.ResultsQualitative analysis of these samples via FTIR and GC-MS identified methamphetamine (38.7%), fentanyl (20.8%), diacetylmorphine (heroin) (10.2%), codeine (5.8%) and alprazolam (4.3%) as the most common illicit substances and the presence of 52 unique adulterants. The most common adulterants included 4-methylaminoantipyrine (4-MAAP) (10.9%), mannitol (9%), acetaminophen (8.5%), methamphetamine (4.2%), diacetylmorphine (heroin) (3.6%), tramadol (1.9%), and xylazine (1.7%). Several additional pharmacologically active adulterants and contaminants of interest were also identified.ConclusionThis analysis is vital for public health use and harm reduction efforts at the level of the individual consumer. Continued direct surveillance of the drug supply is necessary for the detection of potentially harmful adulterants that may pose serious threats to the public.

A model design for managing technological parameters at the stage of the pharmaceutical development of antidiabetic drugs in the form of solid dosage forms

Aim. To develop a model for managing technological parameters at the stage of the pharmaceutical development of an antidiabetic drug in tablets with API of SGLT-2 class – a derivative of gliflozin. Materials and methods. In the study conducted, the methods of system and comparative analysis, generalization, statistical processing and synthesis were used in determining the projected prospects, design, modeling, mathematical modeling, tabular and graphic means of presenting the results. To implement the goals and objectives of the study, software and electronic resources of the Anatomical Therapeutically Chemical Classification System (ATC), Biopharmaceutical Classification System (BCS), Compendium, State Register of Medicines of Ukraine were used; statistical data and data from clinical studies of the content were as follows: https://www.wipo.int; https://www.dec.gov.ua; https://www.clinicaltrials.gov; https://www.ncbi.nlm. nih.gov; https://eacpt.org; https://bpspubs.onlinelibrary.wiley.com. The study was conducted on the modern equipment for determining the bulk density (ERWEKA SVM 202, Germany), the flowability of powders (ERWEKA GT, Germany), resistance to crushing (ERWEKA TBH-525 WTO, Germany), friability (ERWEKA TAR 200, Germany), disintegration (ERWEKA ZT 33, Germany). The active ingredient in tablets of the antidiabetic drug is API calculated with reference to the content of dapagliflozin, 5 mg. The following excipients from the groups of fillers (factor A) were used: a1 – microcrystalline cellulose (MCC) of grade 200, a2 – lactose monohydrate of grade 80, a3 – a mixture of MCC of grade 102 with anhydrous lactose of grade 22 AN in the ratio of 3:1; disintegrants (factor B): b1 – crospovidone XL-10, b2 – sodium croscarmellose, b3 – sodium starch glycolate, glidants (factor C): c1 – colloidal anhydrous silicon dioxide (aerosil 200), c2 – talc, c3 – polyethylene glycol (PEG) 8000, as well as magnesium stearate as a lubricant. The experimental data were subjected to statistical processing by the method of variance analysis. Results and discussion. The development and introduction of new pharmaceuticals, effective analogs and generics is an important task as it contributes to the improvement of the quality of drug supply, treatment and safe use for patients with diabetes mellitus. A model for managing technological parameters at the stage of the pharmaceutical development has been developed; the target quality profile of the antidiabetic drug and tablets with API of SGLT-2 class – a derivative of gliflozin has been substantiated, and critical quality indicators have been determined. According to the model proposed, the optimal composition and technology of antidiabetic tablets with API of SGLT-2 class – a derivative of gliflozin calculated with reference to dapagliflozin, 5 mg, have been developed using an experiment planning matrix based on a 3*3 hyper-Greek-Latin square of the second order; the excipients have been selected; the effect of qualitative and quantitative factors and technological parameters on the pharmaco-technological properties of the tablet masses studied and tablet quality indicators, as well as critical indicators of the quality of the pharmaceutical product have been determined. Experimental studies and risk assessment have been carried out; based on the results, the optimal parameters of the technological process for the production of the antidiabetic drug in tablets with API of SGLT-2 class – a derivative of gliflozin – dapagliflozin have been substantiated. Conclusions. Based on the results of the system analysis of the application of mathematical models in the production of pharmaceutical forms, it has been determined that mathematical modeling is a key stage for ensuring the quality of the technological process at the stage of the pharmaceutical development of an antidiabetic drug in tablets with API of SGLT-2 class – a derivative of gliflozin. The use of mathematical modeling in the course of the pharmaceutical development allows optimization at the stage of the experimental research of API, its polymorphic form, physico-chemical properties and pharmaco-technological indicators. A model for managing technological parameters at the stage of the pharmaceutical development has been proposed; the target quality profile of the antidiabetic drug and tablets with API of SGLT-2 class – a derivative of gliflozin has been substantiated; the optimal composition and technology of this pharmaceutical product has been developed.

Drug procurement and coordination decision under non‐directed donation behavior

AbstractThe frequent occurrence of public emergencies seriously threatens human health. As the supplier of drugs, besides producing drugs, pharmaceutical manufacturers also actively launch drug donations. However, whether this donation will affect the procurement decisions of hospital pharmacies and help relieve the supply pressure is worthy of attention. This paper aims to analyze the procurement and donation decisions under non‐directed donation scenario. Besides, we extend the application of collaborative decisions in the pharmaceutical supply chain. Our results point out that donations made by the pharmaceutical manufacturer always benefit the hospital pharmacy and the pharmaceutical supply chain system, and only in certain circumstances can it make itself more profitable. In non‐directed donation scenario, drug donation and procurement quantities under centralized decision are always higher than that under decentralized decision. The social collaborative decision has more advantages in improving members' decisions and profits. The coordination effect of collaborative decisions is often better when there are significant fluctuations in the wholesale price. Through our analysis, it can provide a reference for pharmacies and pharmaceutical manufacturers to make appropriate procurement and donation decisions.

Denial of prescription pain medication among people who use drugs in Vancouver, Canada

BackgroundPeople who use drugs experience pain at two to three times the rate of the general population and yet continue to face substantial barriers to accessing appropriate and adequate treatment for pain. In light of the overdose crisis and revised opioid prescribing guidelines, we sought to identify factors associated with being denied pain medication and longitudinally investigate denial rates among people who use drugs.MethodsWe used multivariable generalized estimating equations analyses to investigate factors associated with being denied pain medication among people who use drugs reporting pain in three prospective cohort studies in Vancouver, Canada. Analyses were restricted to study periods in which participants requested a prescription for pain from a healthcare provider. Descriptive statistics detail denial rates and actions taken by participants after being denied.ResultsAmong 1168 participants who requested a prescription for pain between December 2012 and March 2020, the median age was 47 years and 63.0% were male. Among 4,179 six-month observation periods, 907 (21.7%) included a report of being denied requested pain medication. In multivariable analyses, age was negatively associated with prescription denial (adjusted odds ratio [AOR] = 0.98, 95% confidence interval [CI]:0.97–0.99), while self-managing pain (AOR = 2.48, 95%CI:2.04–3.00), experiencing a non-fatal overdose (AOR = 1.51, 95%CI:1.22–1.88), engagement in opioid agonist therapy (AOR = 1.32, 95%CI:1.09–1.61), and daily use of heroin or other unregulated opioids (AOR = 1.32, 95%CI:1.05–1.66) were positively associated with being denied. Common actions taken (n = 895) after denial were accessing the unregulated drug supply (53.5%), doing nothing (30.6%), and going to a different doctor/emergency room (6.1%). The period following the introduction of new prescribing guidelines was not associated with a change in denial rates.ConclusionsA substantial proportion of people who use drugs continue to be denied prescriptions for pain, with such denial associated with important substance use-related harms, including non-fatal overdose. Guidelines specific to the pharmaceutical management of pain among people who use drugs are needed.

Homeless people’s experiences of the illicit drug supply during COVID-19

Purpose The COVID-19 pandemic has affected many industries, and reports indicate that this includes the illicit drug market. Recent research suggests that the homeless are particularly vulnerable during the pandemic, and the UK Government has acted to house rough sleepers. Research is scarce regarding homeless people’s experiences of the illicit drug market. This study aims to explore homeless people’s experiences of the drug supply in the UK during COVID-19. Design/methodology/approach Eight homeless people who use illicit drugs, residing in hostels for homeless people in Southampton, participated in semi-structured one-on-one telephone-based interviews. Findings A thematic analysis revealed five themes: availability of drugs, presence of dealers, quality of drugs, finances and personal experiences. Participants reported varying experiences of the drug supply, with lockdown measures expressed as the main reason for reduced supplies, as users found it difficult to find dealers and generate income for purchasing drugs. Research limitations/implications The results may lack generalisability to the wider population, such as rough sleepers and drug dealers, suggesting a need for further research into people’s experiences of the drug supply during COVID-19. Research on this topic could be more in-depth through the use of research methods that are convenient for the homeless population. Practical implications Services should invest in harm reduction services and encourage homeless people who use drugs to engage in substitution treatment. Homeless services should provide psychological support for homeless people who use drugs. Social implications The changes in homeless people’s behaviour following the pandemic may have implications for their interactions with the rest of society (e.g. begging in town centres may reduce). These changes in behaviour may also change the way society can best support homeless people. Originality/value The results are partially consistent with other research findings about the illicit drug supply; however, they also suggest that some individuals experienced minimal change in the illicit drug supply.

Factors Affecting the Success of the National Tuberculosis Control Program in Hospitals in Indonesia Based on the National Hospital Accreditation Standards (SNARS): A Scoping Review

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Tuberculosis (TB) is an infectious disease that is one of the leading causes of health problems worldwide and in developing countries. Hospitals have a very important role in the success of Tuberculosis control programs. Tuberculosis prevention and control encompass a range of health initiatives that are designed to safeguard public health, mitigate morbidity, disability, and death rates, disrupt the spread of the illness, combat medication resistance, and alleviate the adverse consequences associated with Tuberculosis. This scoping review aims to assess the factors that influence the success of the national tuberculosis control program in hospitals based on the National Hospital Accreditation Standards. A scoping review was conducted in this work, utilizing four databases: Google Scholar, Ebsco, Pro Quest, and Science Direct. The PRISMA Flowchart is a tool used to guide the process of selecting research publications. The inclusion exclusion criteria in the article search were limited to the last 10 years, starting from 2014 to 2023. The results of the scoping review showed that the factors influencing the success of the national tuberculosis program in hospitals based on the National Hospital Accreditation Standards are health promotion, early detection of tuberculosis or health screening, tuberculosis surveillance, risk factor control, surveillance of tuberculosis case finding and treatment, provision of immunity with vaccines and provision of tuberculosis preventive drugs. And in an effort to enhance the effectiveness of the Tuberculosis program, the government, hospitals, and communities should prioritize the implementation of the Directly Observed Treatment Shortcourse program in hospitals to ensure its smooth execution</em></p><p><em> </em></p></td></tr></tbody></table></div><strong><em>Keywords: Tuberculosis, Hospital, Program</em></strong>

Effect of community-based newborn care implementation strategies on access to and effective coverage of possible serious bacterial infection (PSBI) treatment for sick young infants during COVID-19 pandemic.

In Ethiopia, neonatal mortality is persistently high. The country has been implementing community-based treatment of possible serious bacterial infection (PSBI) in young infants when referral to a hospital is not feasible since 2012. However, access to and quality of PSBI services remained low and were worsened by COVID-19. From November 2020 to June 2022, we conducted implementation research to mitigate the impact of COVID-19 and improve PSBI management implementation uptake and delivery in two woredas in Ethiopia. In April-May 2021, guided by implementation research frameworks, we conducted formative research to understand the PSBI management implementation challenges, including those due to the COVID-19 pandemic. Through a participatory process engaging stakeholders, we designed adaptive implementation strategies to bridge identified gaps using mechanism mapping to achieve implementation outcomes. Strategies included training and coaching, supportive supervision and mentorship, technical support units, improved supply of essential commodities, and community awareness creation about PSBI and COVID-19. We conducted cross-sectional household surveys in the two woredas before (April 2021) and after the implementation of strategies (June 2022) to measure changes in targeted outcomes. We interviewed 4,262 and 4,082 women who gave live birth 2-14 months before data collection and identified 374 and 264 PSBI cases in April 2021 and June 2022, respectively. The prevalence of PSBI significantly decreased (p-value = 0.018) from 8.7% in April 2021 to 6.4% while the mothers' care-seeking behavior from medical care for their sick newborns increased significantly from 56% to 91% (p-value <0.01). Effective coverage of severely ill young infants that took appropriate antibiotics significantly improved from 33% [95% CI: 25.5-40.7] to 62% [95% CI: 51.0-71.6]. Despite improvements in the uptake of PSBI treatment, persisting challenges at the facility and systems levels impeded optimal PSBI service delivery and uptake, including perceived low quality of service, lack of community trust, and shortage of supplies. The participatory design and implementation of adaptive COVID-19 strategies effectively improved the uptake and delivery of PSBI treatment. Support systems were critical for frontline health workers to deliver PSBI services and create a resilient community health system to provide quality PSBI care during the pandemic. Additional strategies are needed to address persistent gaps, including improvement in client-provider interactions, supply of essential drugs, and increased social mobilization strategies targeting families and communities to further increase uptake.

Implementing Post-Pandemic Economic Parity: A Potential Restoration Through Distributive Justice

Abstract This paper explores the economic disparities created and augmented by the Pandemic and implores the state to adopt redistribution schemes based on the philosophy of distributive justice. The pandemic created and augmented gaping class inequalities, by pushing some into unemployment and poverty, while catalysing others’ prosperity. This may or may not have involved a fault element on the part of those that profited from the pandemic, which is to say, while some may have actively exploited the situation to increase their profits at the cost of general interests, others may have simply gained profits while retaining ethical practices in their conduct of business. This Paper argues that, irrespective of the fault element, States must implement a special financial scheme that necessitates companies that gained enormous profits from the pandemic to contribute towards assisting those who were financially crushed by the pandemic. The paper will build this on the philosophy of distributive justice, examining the ‘difference principle’ as well as ‘luck and responsibility egalitarianism’. Simply put, this means that States must enforce a system that neutralizes the ‘luck’ element that the pandemic induced in the society, through a financial scheme best suited for its situation. This may be achieved through levying a special tax for a period of time on particular business entities and/or by requiring companies to include a special corporate social responsibility project in line with the quantum of additional profits owing to the pandemic. Arguably, corporate houses that exploited the pandemic must not be placed at par with those that merely happened to profit from it (say, for instance, a pharmaceutical company that may have manipulated the drug market to increase prices and limit supply of an important drug, as opposed to a food/essentials delivery chain that naturally saw an increase in the number of consumers ordering deliveries online). But the obligation to carve out a part of their profits for social redistribution is not founded on whether they are at fault or not. Any fault may, of course, be used as a basis for levying a higher penalty or other legal measure, apart and distinct from the obligation that this paper builds on. The scheme that is proposed by the Paper is not to penalize but is based on the philosophy of distributive justice and thus does not require that the company was ever in violation of laws, but merely that the pandemic that devastated most people happened to be a profitable enterprise for others in contrast. It is in the State’s interests to negate the widened gap of economic disparities thus created, and this justifies that the Government would require such corporate houses to carve out a fraction of their fortunes for those who suffered severely. The Paper builds primarily on the philosophical foundations of distributive justice, urging its practical implementation in post-pandemic the economy. States must adopt creative measures to restructure patterns of privileges created or amplified by such unprecedented (at least in recent history) circumstances, as the pandemic.