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Collaboration between private pharmacies and national tuberculosis programme: an intervention in Bolivia

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Summary Background

Public–private partnerships are felt to be necessary for tuberculosis (TB) control in some developing countries. Objectives

To evaluate the potential of a collaboration between the National TB Programme (NTP) and private pharmacies in Bolivia, the country with the highest TB incidence in Latin America. Methods

We contacted the local Pharmacists’ Association in the city of Cochabamba, and designed a two phase intervention. The objectives of the first phase were to decrease the availability of TB drugs in private pharmacies on a voluntary basis, and to improve referral of clients seeking TB drugs to the NTP. A survey of all pharmacies allowed for a before–after comparison with a baseline survey. The objectives of the second phase were to obtain referral of pharmacy clients with chronic cough for TB screening in the NTP. This phase was started in 70 pharmacies and evaluated after 2 months using the referral slips issued by the pharmacists. Results

The proportion of pharmacies selling TB drugs decreased (rifampicin: 23–11.5%; isoniazid: 16–3.1%; P < 0.001) and the proportion of pharmacies referring to the NTP clients seeking TB drugs increased (22–58%; P < 0.0001). In the second phase, 26 of 70 pharmacies (38%) referred a total of 41 clients for screening in the NTP (i.e. an average of 0.29 clients per pharmacy and per month); 11 of 41 (27%) were screened and three of 11 (27%) diagnosed with smear-positive TB. Conclusion

The first phase of the intervention proved effective in reducing the availability of the main TB drugs in pharmacies, and in improving referral of clients seeking TB drugs. Key factors in this success were not specific to Bolivia, and collaboration between private pharmacies and public services appears possible in that respect. However, collaboration with pharmacies does not seem an efficient way to increase the number of patients screened for TB, and to shorten delays to TB diagnosis and treatment.
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Keywords: Bolivia; public-private partnership pharmacies; tuberculosis; tuberculosis control private sector

Document Type: Research Article

Affiliations: 1: Epidemiology and Diseases Control Unit, Department of Public Health, Institute for Tropical Medicine, Antwerp, Belgium 2: Instituto de Investigacion Biomedica (IIBISMED), Facultad de Medicina, Universidad Mayor de San Simon, Cochabamba, Bolivia 3: Belgian Technical Cooperation, Brussels, Belgium 4: Veterinary Department, Institute for Tropical Medicine, Antwerp, Belgium

Publication date: March 1, 2005

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