Chukwu Otuto Amarauche, Adewole Isaac Folorunso, Denburg Avram, Essue Beverley M
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Gynecological Oncology Unit, Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
PLOS Glob Public Health. 2024 Sep 6;4(9):e0003275. doi: 10.1371/journal.pgph.0003275. eCollection 2024.
Children and adolescents in developing countries continue to be disproportionately affected by cancer and have significantly lower survival rates (30%) than their counterparts in high-income countries (80%). This disparity is driven by poor access to childhood cancer medicines. The World Health Organization and St. Jude Children's Research Hospital launched the Global Platform for Access to Childhood Cancer Medicines to provide continuous supply of quality childhood cancer medicines to developing countries. As much movement has not been seen with the platform, this research aimed to develop a stakeholder-informed guidance to support effective implementation of the platform and maximize opportunities to deliver on its intended goals. This study was guided by the Consolidated Framework for Implementation Research (CFIR). Participants were recruited based on the stakeholder categories framework and included policymakers from the Ministry of Health, organizations implementing access to medicines programs in Nigeria, medicines logistics providers, and health professionals and personnel at service delivery points such as oncologists and pharmacists. Data collection involved key informant interviews using a pilot-tested semi-structured interview guide. Data analysis was done by thematic content analysis. Ethical approval was obtained from the National Health Research Ethics Committee of Nigeria and the Ethics Review Board of University of Toronto. The findings reveal critical insights spanning five domains of the CFIR framework, each contributing uniquely to understanding the multifaceted issues of childhood cancer medicine access with a view to understanding pathways to implementation of the platform. Successfully implementing the platform could entail a partner-driven approach, integration with existing programs to avoid fragmentation, supporting capacity strengthening at the primary care level, and engaging patients and communities. This information was used to suggest a nuanced implementation framework for the platform in Nigeria and similar settings which could be beneficial for improving access for children who desperately need childhood cancer medicines to survive.
发展中国家的儿童和青少年受癌症影响的比例仍然过高，其生存率（30%）显著低于高收入国家的同龄人（80%）。这种差异是由于难以获得儿童癌症药物所致。世界卫生组织和圣裘德儿童研究医院发起了全球儿童癌症药物获取平台，以便向发展中国家持续供应优质儿童癌症药物。由于该平台尚未见有太多进展，本研究旨在制定一份基于利益相关者意见的指南，以支持该平台的有效实施，并最大限度地增加实现其既定目标的机会。本研究以实施研究综合框架（CFIR）为指导。根据利益相关者类别框架招募参与者，包括卫生部的政策制定者、在尼日利亚实施药品获取项目的组织、药品物流供应商，以及诸如肿瘤学家和药剂师等服务提供点的卫生专业人员和工作人员。数据收集采用经预测试的半结构化访谈指南进行关键 informant 访谈。数据分析通过主题内容分析完成。获得了尼日利亚国家卫生研究伦理委员会和多伦多大学伦理审查委员会的伦理批准。研究结果揭示了跨越CFIR框架五个领域的关键见解，每个领域都为理解儿童癌症药物获取的多方面问题做出了独特贡献，以期了解该平台的实施途径。成功实施该平台可能需要采取由合作伙伴驱动的方法，与现有项目整合以避免碎片化，支持基层医疗层面的能力建设，并让患者和社区参与进来。这些信息被用于为尼日利亚及类似环境中的该平台提出一个细致入微的实施框架，这可能有助于改善那些急需儿童癌症药物以生存的儿童的药物获取情况。
