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Journal Article > ResearchFull Text

Southern african HIV clinicians society guideline for the prevention, diagnosis and management of cryptococcal disease among HIV-infected persons: 2019 update

Southern African Journal of HIV medicine. 8 November 2019; Volume 20 (Issue 1); 1030.; DOI:10.4102/sajhivmed.v20i1.1030
Govender NP, Meintjes GA, Mangena PM, Nel J, Potgieter S,  et al.
Southern African Journal of HIV medicine. 8 November 2019; Volume 20 (Issue 1); 1030.; DOI:10.4102/sajhivmed.v20i1.1030
Journal Article > ResearchFull Text

Time to embrace access programmes for medicines: Lessons from the South African flucytosine access programme

Int J Infect Dis. 1 June 2020; Volume 95; 459-461.; DOI:10.1016/j.ijid.2020.02.057
Shroufi A, Govender NP, Meintjes GA, Black JM, Nel J,  et al.
Int J Infect Dis. 1 June 2020; Volume 95; 459-461.; DOI:10.1016/j.ijid.2020.02.057
BACKGROUND
Cryptococcal Meningitis (CM) is estimated to cause 181,000 deaths annually; with the majority occurring in Sub Saharan Africa. Flucytosine is recommended by the World Health Organization as part of the treatment for CM. Widespread use of flucytosine could reduce mortality in hospital by as much as 40% compared to the standard of care, yet due to market failure quality assured flucytosine remains unregistered and largely inaccessible throughout Africa.

METHODS
The recently established South African flucytosine clinical access programme is an attempt to address market failure which led to a lack of public-sector access to flucytosine for cryptococcal meningitis, by making the medicine freely available to tertiary hospitals in South Africa.

RESULTS
Between November 2018 and September 2019, 327 CM patients received flucytosine through this programme, with efforts to support sustainable national scale up presently ongoing. We describe why this programme was needed, its catalytic potential, what is still required to ensure widespread access to flucytosine, and observation from this experience that may have wider relevance.

CONCLUSIONS
The South African Flucytosine Access Programme illustrates how access programmes may be one part of the solution to addressing the vicious cycle of perceived low demand, limiting manufacturer interest in specific product markets.
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