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Genital Ulcer Disease Treatment Policies and Access to Acyclovir in Eight Sub-Saharan African Countries

Corbell, Catherine BPharm, MSc*; Stergachis, Andy PHD†‡; Ndowa, Francis MBChB§; Ndase, Patrick MBChB, MPH; Barnes, Linda MHA; Celum, Connie MD, MPH†‡¶

Sexually Transmitted Diseases: August 2010 - Volume 37 - Issue 8 - p 488-493
doi: 10.1097/OLQ.0b013e3181e212e5
Original Study

Background: Herpes simplex virus-2, the most common cause of genital ulcer disease (GUD) globally, is a cofactor in human immunodeficiency virus type-1 (HIV-1) acquisition and transmission. Current World Health Organization guidelines for sexually transmitted infections recommend acyclovir as first-line syndromic treatment of GUD in countries with high herpes simplex virus-2 prevalence (≥30%).

Objective: To assess the extent of adoption of acyclovir as syndromic treatment for GUD, and describe procurement, distribution, and cost of acyclovir in the public and private sectors of 8 sub-Saharan African countries.

Methods: We conducted standardized interviews with Ministry of Health (MoH) officials, pharmacists, and other pharmacy workers based in the public and private sectors. Interviews were conducted in Botswana, Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Price comparisons were conducted using the 2007 median international reference price (IRP) for acyclovir.

Results: Of the 8 African countries, 4 surveyed had adopted acyclovir as first-line syndromic GUD treatment in both their essential medical lists and sexually transmitted infection guidelines. Country-specific acquisition prices for acyclovir 200 mg were comparable to the median IRP and ranged from 0.74 to 1.95 times the median IRP. The median retail cost of acyclovir in the private sector ranged from 5.85 to 9.76 times the median IRP. Public health facilities faced cost and regulatory barriers that impeded the requisitioning of acyclovir from the central medical stores.

Conclusions: Systems for drug procurement, distribution, and access in sub-Saharan African countries need strengthening for a GUD treatment policy using acyclovir to be effective.

A survey of Ministry of Health officials and pharmacists in 8 sub-Saharan African countries on policies, procurement, distribution, and access related to acyclovir for syndromic treatment of genital ulcer disease.

From the Departments of *Pharmacy, †Global Health, and ‡Epidemiology, University of Washington, Seattle, WA; §Department of Reproductive Health & Research, World Health Organization, Geneva, Switzerland; and ¶Department of Medicine, University of Washington, Seattle, WA

The authors thank the following for their help with facilitating and conducting this study. They are Dr. Kenneth Mugwanya (Uganda, also involved in initial efforts of developing survey concept), Dr. Cosmas Chike Ekezie (Botswana), Dr. Nelly Mugo (Kenya), Dr. Kenneth Ngure (Kenya), Dr. Harrison Tamooh (Kenya), Dr. James Kiarie (Kenya), Dr. Edwin Were (Kenya), Dr. Elizabeth Bukusi (Kenya), Josephine Odoyo (Kenya), Alfred Obiero (Kenya), Dr. Andrew Mujugira (South Africa), Dr. Sinead Delany-Moretlwe (South Africa), Dr. Guy de Bruyn (South Africa), Dr. David Coetzee (South Africa), Pather Thavashini (South Africa), Dr. Rachel Manongi (Tanzania), Msafiri Swai (Tanzania), Linda Luyiga Kavuma (Uganda), Dr. Edith Nakku-Joloba (Uganda), Dr. Elly Katabira (Uganda), Dr. Stewart Reid Zambia), Billy Mweewta (Zambia), Benedict Tembo (Zambia), Euphemia Sibanda (Zimbabwe), Frances Cowan (Zimbabwe), Ellen Wilcox (USA), and WHO country and regional offices. The authors also thank all the Ministry of Health officials and pharmacists and other pharmacy workers who agreed to be interviewed.

Supported by World Health Organization.

Correspondence: Andy Stergachis, PhD, Department of Epidemiology, University of Washington, Box 357236, Seattle, WA 98195. E-mail:

Received for publication September 16, 2009, and accepted January 14, 2010.

© Copyright 2010 American Sexually Transmitted Diseases Association