了解兽医伊维菌素在恰加斯病中的广泛使用、潜在因素及其对 COVID-19 大流行的影响：一项收敛混合方法研究。
Understanding the widespread use of veterinary ivermectin for Chagas disease, underlying factors and implications for the COVID-19 pandemic: a convergent mixed-methods study.
机构信息
Department of Medical and Social Projects, DAHW, Würzburg, Germany.
Medical Department, Centro Integral Dermatológico, Monteagudo, Plurinational State of Bolivia.
出版信息
BMJ Open. 2022 Sep 17;12(9):e058572. doi: 10.1136/bmjopen-2021-058572.
OBJECTIVES
Veterinary ivermectin (vet-IVM) has been used widely in Latin America against COVID-19, despite the lack of scientific evidence and potential risks. Widespread vet-IVM intake was also discovered against Chagas disease during a study in Bolivia prior to the pandemic. All vet-IVM-related data were extracted to understand this phenomenon, its extent and underlying factors and to discuss potential implications for the current pandemic.
DESIGN
A convergent mixed-methods study design including a survey, qualitative in-depth interviews (IDI) and focus group discussions (FGD).
SETTING
A cross-sectional study conducted in 2018 covering the geographic area of Monteagudo, an endemic municipality for Chagas disease.
PARTICIPANTS
A total of 669 adult household representatives from 26 communities participated in the survey, supplemented by 14 IDI and 2 FGD among patients, relatives and key informants.
RESULTS
9 IDI and 2 FGD contained narratives on vet-IVM use against Chagas disease. Five main themes emerged: (1) the extent of the vet-IVM phenomenon, (2) the perception of vet-IVM as a treatment for Chagas disease, (3) the vet-IVM market and the controversial role of stakeholders, (4) concerns about potential adverse events and (5) underlying factors of vet-IVM use against Chagas disease.In quantitative analysis, 28% of participants seropositive for Chagas disease had taken vet-IVM. Factors associated with multivariate analysis were advanced age (OR 17.01, 95 CI 1.24 to 36.55, p=0.027 for age above 60 years), the experience of someone close as information source (OR 3.13, 95 CI 1.62 to 5.02, p<0.001), seropositivity for Chagas disease (OR 3.89, 95 CI 1.39 to 6.20, p=0.005) and citing the unavailability of benznidazole as perceived healthcare barrier (OR 2.3, 95 CI 1.45 to 5.18, p=0.002). Participants with an academic education were less likely to report vet-IVM intake (OR 0.12, 95 CI 0.01 to 0.78, p=0.029).
CONCLUSIONS
Social determinants of health, the unavailability of treatment and a wonder drug image might contribute to the phenomenon of vet-IVM.
目的
兽医伊维菌素（vet-IVM）已在拉丁美洲广泛用于对抗 COVID-19，尽管缺乏科学证据和存在潜在风险。在大流行之前，玻利维亚的一项针对恰加斯病的研究也发现了广泛摄入兽医 IVM 的情况。提取了所有与兽医 IVM 相关的数据，以了解这种现象、其程度和潜在因素，并讨论其对当前大流行的潜在影响。
设计
包括调查、定性深入访谈（IDI）和焦点小组讨论（FGD）的收敛混合方法研究设计。
地点
2018 年在恰加斯病流行的蒙特阿古多地区进行的一项横断面研究。
参与者
共有 26 个社区的 669 名成年家庭代表参加了调查，并对患者、亲属和主要知情人进行了 14 次 IDI 和 2 次 FGD。
结果
9 次 IDI 和 2 次 FGD 包含了关于兽医 IVM 用于治疗恰加斯病的叙述。出现了 5 个主要主题：（1）兽医 IVM 现象的程度，（2）兽医 IVM 作为恰加斯病治疗方法的看法，（3）兽医 IVM 市场和利益相关者有争议的角色，（4）对潜在不良事件的担忧，（5）兽医 IVM 用于治疗恰加斯病的潜在因素。在定量分析中，28%的恰加斯病血清阳性参与者服用了兽医 IVM。多变量分析相关的因素是年龄较大（OR 17.01，95%CI 1.24 至 36.55，p=0.027 岁以上 60 岁）、亲近的人作为信息来源（OR 3.13，95%CI 1.62 至 5.02，p<0.001）、恰加斯病血清阳性（OR 3.89，95%CI 1.39 至 6.20，p=0.005）和认为苯并咪唑不可用是医疗保健障碍的感知（OR 2.3，95%CI 1.45 至 5.18，p=0.002）。具有学术教育背景的参与者不太可能报告服用兽医 IVM（OR 0.12，95%CI 0.01 至 0.78，p=0.029）。
结论
健康的社会决定因素、治疗方法的缺乏和神奇药物的形象可能促成了兽医 IVM 的现象。
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