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Background: The capacity for social media to influence the consumption of re-purposed medicines to manage COVID-19 despite limited safety and efficacy data at the start of the pandemic is cause for concern. Objective: To ascertain links between social media reports and utilization for three re-purposed medicines (hydroxychloroquine (HCQ), ivermectin and colchicine) to direct future activities. Methods: A combined retrospective analysis of social media posts for these re-purposed medicines was performed in South Africa between January and June 2021 together with utilization and clinical trials data. Utilisation data from IQVIA from three different platforms included private and public markets. Clinical trials data was obtained from various databases. Chloroquine data was analysed in South Africa (HCQ was not available). Results: 77257 posts were collected across key social media platforms during the study period of which 6884 were relevant. Ivermectin had the highest number of posts (55%) followed by HCQ (44%), with limited posts for colchicine (1%). The spike in ivermectin utilisation was closely correlated with social media posts. Similarly, with chloroquine social media interest was enhanced by comments from local politicians. Sentiment analysis showed that the posts regarding the effectiveness of particularly ivermectin and HCQ were positive. Of concern is that the origin of the majority of reporters in social media (85%) was unidentifiable. Conclusion: This is the first study of its kind in South Africa providing evidence that social media is a driver of re-purposed medicine use. Healthcare professionals have a key role to provide evidence-based advice especially with unidentifiable posts.

Background: People with mental disorders are more vulnerable to human immunodeficiency virus (HIV) infection. A part of first-line treatment for HIV, efavirenz, is routinely avoided in patients with mental illness due to the risk of potential aggravation of the mental illness. This study aimed to determine the outcomes of people living with HIV/AIDS who were mental healthcare users admitted to two public-sector psychiatric facilities and who were prescribed an efavirenz-containing regimen. Materials and Methods: A retrospective drug utilization study was conducted at two public-sector psychiatric hospitals in the Eastern Cape of South Africa. Patients aged 18 years or older living with HIV were included in the study. Follow-up reviews were conducted at four, 12 and 24 weeks. The patients were seen by doctors at the hospital and notes on progress and medication were recorded in medical records. The files were then reviewed. Results: A total of 37 patients were enrolled. However, just 26 were reviewed at 24 weeks. A total of 43.2% (n=16) were female patients and the average age of the patients was 39.38±8.76 years. At the baseline, 32.4% (n=12) patients were diagnosed with schizophrenia. A total of 81.08% (n=30) of patients experienced an improvement in psychiatric symptoms after 24 weeks. Of these, 43.3% (n=13) were on an efavirenz-containing regimen. Conclusion: Majority of the patients demonstrated an improvement in their psychiatric conditions to the extent that they were discharged into the community. This finding suggests that patients with psychiatric disorders on efavirenz can experience stabilisation of their psychiatric symptoms.

\(\it Hintergrund:\) Eine Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Kindesalter stellt einen Risikofaktor für Substanzmissbrauch und Störungen durch Substanzgebrauch (Substance Use Disorder, SUD) in der Pubertät und dem (frühen) Erwachsenenalter dar. ADHS und SUD treten auch häufig bei therapiesuchenden Jugendlichen auf, was die Diagnosestellung und Therapie erschwert sowie mit schlechten Behandlungsergebnissen verbunden ist. Forschungsergebnisse über die Wirkung der Behandlung von ADHS im Kindesalter auf die Prävention von SUD im Jugendalter sind nicht eindeutig und Studien über die Diagnose und Behandlung von Jugendlichen mit ADHS und SUD sind selten. Daher reicht die verfügbare Evidenz allgemein nicht aus, um starke Behandlungsempfehlungen zu rechtfertigen. \(\it Fragestellung:\) Ziel dieser Arbeit war es, eine Konsenserklärung auf der Grundlage von wissenschaftlichen Daten und klinischen Erfahrungen zu erhalten. \(\it Methodik:\) Es wurde eine modifizierte Delphi-Studie durchgeführt, um basierend auf der Kombination von wissenschaftlichen Daten und klinischer Erfahrung mit einer multidisziplinären Gruppe von 55 Expert_innen aus 17 Ländern einen Konsens zu erzielen. Die Expert_innen wurden gebeten, eine Reihe von Aussagen über die Wirkung der Behandlung von ADHS im Kindesalter auf die SUD bei Jugendlichen sowie über das Screening, die Diagnostik und die Behandlung von Jugendlichen mit komorbidem ADHS und SUD zu bewerten. \(\it \(\it Ergebnisse:\) Nach drei iterativen Bewertungsrunden und der Anpassung von 37 Aussagen wurde ein Konsens über 36 dieser Aussagen erzielt, die sechs Bereiche repräsentieren: allgemein (\(\it n\) = 4), Risiko der Entwicklung einer SUD (\(\it n\) = 3), Screening und Diagnostik (\(\it n\) = 7), psychosoziale Behandlung (\(\it n\) = 5), pharmakologische Behandlung (\(\it n\) = 11) und komplementäre Behandlungen (\(\it n\) = 7). Der Einsatz von Routinescreenings auf ADHS wird bei adoleszenten Patient_innen in einer Suchtbehandlung ebenso wie Routinescreenings auf SUD bei jugendlichen Patient_innen mit ADHS in allgemeinpsychiatrischen Therapiesettings empfohlen. Langwirksame Stimulanzien werden als Behandlung der ersten Wahl von ADHS bei Jugendlichen mit gleichzeitiger ADHS und SUD empfohlen. Die Pharmakotherapie sollte vorzugsweise in psychosoziale Behandlung eingebettet werden. Die einzige nichtkonsentierte Aussage betraf die Notwendigkeit von Abstinenz vor Beginn einer pharmakologischen Behandlung bei Jugendlichen mit ADHS und gleichzeitigem SUD. Im Gegensatz zur Mehrheit verlangten einige Expert_innen eine vollständige Abstinenz vor Beginn einer pharmakologischen Behandlung, einige waren gegen die Verwendung von Stimulanzien bei der Behandlung dieser Patient_innen (unabhängig von Abstinenz), während einige sich gegen die alternative Anwendung von Bupropion aussprachen. \(\ Schlussfolgerungen:\) Diese internationale Konsenserklärung kann von Kliniker_innen und Patient_innen zusammen in einem gemeinsamen Entscheidungsprozess genutzt werden, um die besten Interventionen auszuwählen und die bestmöglichen Ergebnisse bei adoleszenten Patient_innen mit gleichzeitiger ADHS und SUD zu erzielen. \(\it Background:\) Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. \(\it Objective:\) The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. \(\it Method:\) A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. \(\it Results:\) After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (\(\it n\) = 4), risk of developing SUD (\(\it n\) = 3), screening and diagnosis (\(\it n\) = 7), psychosocial treatment (\(\it n\) = 5), pharmacological treatment (\(\it n\) = 11), and complementary treatments (\(\it n\) = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. \(\it Conclusion:\) This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Neelaveni Padayachee,1 Alan D Rothberg,2 Ilse Truter,3 Neil Butkow11Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa; 2School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa; 3Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South AfricaIntroduction: In South Africa there is an easy access to over-the-counter (OTC) medicines and expenditure is high. Certain OTC products are available to the public in general stores, while others may only be available at pharmacies. It is also common for OTC medicines to be prescribed by a doctor for treatment of minor illnesses. Individuals with medical insurance usually have cover for these products, but typically only to a limited extent.Aim: To investigate the utilization patterns in two medical insurance schemes of OTC analgesic products in the Anatomical Therapeutic Chemical (ATC) category N02BE51 which includes medicines containing paracetamol and varying combinations of codeine, caffeine and antihistamines.Methodology: Data were obtained for two benefit plans, one with generous, high benefits (HI), the other with lower benefits (LO). Data covered utilization of OTC medicines in the N02BE51 group, indicating whether the medicines were purchased at a pharmacy or dispensed by a doctor. Doctors were further categorised as contracted/network or non-network providers. Product costs and volumes were analysed according to access directly by the beneficiary, recommendation by a pharmacist, or prescription from a doctor.Results: Compared to doctors, pharmacists issued more-expensive products. Average costs were higher in the HI plan compared to the LO plan. Pharmacists showed a preference for dispensing larger and more expensive pack sizes. Doctors showed better cost containment: the average cost of products in HI was twice that of LO. Doctors dispensing directly to patients issued smaller pack sizes and lower-priced products. Contracted network doctors did not appear to impact on costs.Conclusion: Among the privately-insured individuals studied, the avaiIability, cost and formulation of N02BE51 OTC products appeared to be poorly regulated, whether by the consumer, pharmacist, medical insurance scheme or legislation. Doctors demonstrate better cost containment by prescribing less costly, smaller pack-size alternatives compared to pharmacists.Keywords: paracetamol, codeine, anti-histamines, pharmacists, doctors, cost, pack size &nbsp

Hintergrund: Eine Aufmerksamkeitsdefizit-/Hyperaktivit��tsst��rung (ADHS) im Kindesalter stellt einen Risikofaktor f��r Substanzmissbrauch und St��rungen durch Substanzgebrauch (Substance Use Disorder, SUD) in der Pubert��t und dem (fr��hen) Erwachsenenalter dar. ADHS und SUD treten auch h��ufig bei therapiesuchenden Jugendlichen auf, was die Diagnosestellung und Therapie erschwert sowie mit schlechten Behandlungsergebnissen verbunden ist. Forschungsergebnisse ��ber die Wirkung der Behandlung von ADHS im Kindesalter auf die Pr��vention von SUD im Jugendalter sind nicht eindeutig und Studien ��ber die Diagnose und Behandlung von Jugendlichen mit ADHS und SUD sind selten. Daher reicht die verf��gbare Evidenz allgemein nicht aus, um starke Behandlungsempfehlungen zu rechtfertigen. Fragestellung: Ziel dieser Arbeit war es, eine Konsenserkl��rung auf der Grundlage von wissenschaftlichen Daten und klinischen Erfahrungen zu erhalten. Methodik: Es wurde eine modifizierte Delphi-Studie durchgef��hrt, um basierend auf der Kombination von wissenschaftlichen Daten und klinischer Erfahrung mit einer multidisziplin��ren Gruppe von 55 Expert_innen aus 17 L��ndern einen Konsens zu erzielen. Die Expert_innen wurden gebeten, eine Reihe von Aussagen ��ber die Wirkung der Behandlung von ADHS im Kindesalter auf die SUD bei Jugendlichen sowie ��ber das Screening, die Diagnostik und die Behandlung von Jugendlichen mit komorbidem ADHS und SUD zu bewerten. Ergebnisse: Nach drei iterativen Bewertungsrunden und der Anpassung von 37 Aussagen wurde ein Konsens ��ber 36 dieser Aussagen erzielt, die sechs Bereiche repr��sentieren: allgemein (n = 4), Risiko der Entwicklung einer SUD (n = 3), Screening und Diagnostik (n = 7), psychosoziale Behandlung (n = 5), pharmakologische Behandlung (n = 11) und komplement��re Behandlungen (n = 7). Der Einsatz von Routinescreenings auf ADHS wird bei adoleszenten Patient_innen in einer Suchtbehandlung ebenso wie Routinescreenings auf SUD bei jugendlichen Patient_innen mit ADHS in allgemeinpsychiatrischen Therapiesettings empfohlen. Langwirksame Stimulanzien werden als Behandlung der ersten Wahl von ADHS bei Jugendlichen mit gleichzeitiger ADHS und SUD empfohlen. Die Pharmakotherapie sollte vorzugsweise in psychosoziale Behandlung eingebettet werden. Die einzige nichtkonsentierte Aussage betraf die Notwendigkeit von Abstinenz vor Beginn einer pharmakologischen Behandlung bei Jugendlichen mit ADHS und gleichzeitigem SUD. Im Gegensatz zur Mehrheit verlangten einige Expert_innen eine vollst��ndige Abstinenz vor Beginn einer pharmakologischen Behandlung, einige waren gegen die Verwendung von Stimulanzien bei der Behandlung dieser Patient_innen (unabh��ngig von Abstinenz), w��hrend einige sich gegen die alternative Anwendung von Bupropion aussprachen. Schlussfolgerungen: Diese internationale Konsenserkl��rung kann von Kliniker_innen und Patient_innen zusammen in einem gemeinsamen Entscheidungsprozess genutzt werden, um die besten Interventionen auszuw��hlen und die bestm��glichen Ergebnisse bei adoleszenten Patient_innen mit gleichzeitiger ADHS und SUD zu erzielen.

Introduction: The potentials of Africa for growth and economic transformation through science remains challenging because of existing gaps in knowledge and infrastructure. The Africa Pharmacological Science Gateway project and the Medicines Utilization Research in Africa Group seeks to meet the research needs of African pharmacologists. This study aimed at identifying priority needs that might be met by access to information and tools through e-infrastructure. Methods: A web-based cross-sectional study among 472 members of pharmacological societies in Africa to obtain information on their research interests and skills, available resources, needs and knowledge gaps. Descriptive analyses were done. Results: A total of 118 responses from 13 countries were received, mostly from Nigeria (48.3%) and South Africa (21.3%). Respondents had wide ranges of research interests predominantly in drug utilization research.The desired resources included drug utilization research training and tools, pharmacokinetics and pharmacometrics modelling training and tools, drug-drug interaction and medicine prices resources, statistical analysis resources, access to journals, training in specific laboratory techniques, equipment and funding for research-related activities. Conclusions: Key areas of needs not currently provided by the African Pharmacological Science Gateway e-infrastructure were identified to guide further provision of resources on the e-infrastructure and potentially enhance research capacity within the continent.

Background: Despite advancements in drug utilization research (DUR), these have not been universal. Some regions such as the Latin America (LatAm) and African regions are facing challenges that are impeding the development of DUR. Objectives: To identify the main challenges and issues for DUR in the LatAm and African regions Methods: A collaborative initiative by the International Society of Pharmacoepidemiology Global Development Committee in partnership with the Latin America Drug Utilization Group and the Medicines Utilization Research in Africa Group was undertaken. A comprehensive literature review was conducted to identify local and international DUR publications. A core group of investigators and experts in DUR reviewed the publications and identified the main methodological challenges and issues. Subsequently, the group exchanged materials, participated in WebEx discussions, and reviewed the draft document. Results: Main issues: 1) Socioeconomic: high unemployment rate with poor standard of living, socioeconomic inequalities, low literacy levels, urban segregation, high migration rates, high rates of violent crime including drug trafficking and possession. 2) Healthcare-related: Disparities of social determinants of health, differences in the quality of public and private health sectors; and epidemiologic transition from communicable diseases to non-communicable diseases. Most health care systems are fragmented with variable access to medical care and medicines, and substandard record keeping. 3) Drug utilization-related: Inappropriate use of medicines including the elderly; limited infrastructure to reliably collect DU data; over-prescription of antimicrobials; polypharmacy; high rates of self-medication; and poor patient adherence (e.g. HIV/AIDS, diabetes mellitus and hypertension). Planning for DUR is affected by the multiplicity of drug distribution channels; trading in sub-standard, counterfeit medicines and insufficient quality control centers. Some publications are generated by local investigators, often suffering of methodological issues such as lack of representativeness of the population, limited data validity, and small sample sizes. Conclusions: There are common challenges for DUR when working within the LatAm and African regions. Based on our findings, the group is developing Guidance on Good Practices of Drug Utilization Research in those regions to assist researchers with issues pertaining to the planning, conduct, and evaluation of DUR.

Nonverbal communication is often neglected during the analysis of focus group discussions. The aim of this research was to review the literature regarding the recording of nonverbal communication during focus group discussions. Specific objectives were to identify the methods used to record the nonverbal communication during focus group discussions and how to integrate this component with the verbal communication data obtained. Although it is acknowledged in the literature that nonverbal communication impacts on the themes obtained from focus groups, no methodological guidance is provided for its recording during focus group discussions. There is a lack of literature on the methods used to record, decode and interpret nonverbal communication during focus group discussions. A tool was developed for observers to record the nonverbal communication of students. The tool was tested during focus group discussions in which students’ perceptions regarding substance abuse were explored. To test the tool, one focus group, consisting of eight to 10 randomly selected students, was conducted at each of the four Port Elizabeth campuses of the Nelson Mandela University, South Africa. The recording tool was not successful as important nonverbal observations identified and recorded during the discussions could not be linked to the specific verbal portion of the participants’ messages. Focus groups are vital in exploring the perceptions of people in health research. Themes identified from focus groups can be more meaningful if nonverbal communication, in addition to verbal communication, is also considered during data analysis.Keywords: Focus group discussions, nonverbal communication, nonverbal communication recording tool, health research.

More than two billion people worldwide are infected with helminths. The primary aim of the study was to evaluate the dispensing patterns of anthelmintic products using dispensing data of South African community pharmacies. A retrospective, cross-sectional drug utilisation study was conducted on a 2013 community pharmacy dispensing database. A total of 252 248 anthelmintic products were dispensed to 176 931 persons (66.02% females) during 2013. The average age of persons to whom anthelmintic products were dispensed was 40.20 (SD=11.93) years. Four anthelmintic active ingredients were dispensed, namely albendazole, mebendazole, praziquantel and niclosamide. Mebendazole dominated the dispensing of anthelmintic products in this study, constituting 95.33% of the number of products and 92.60% of cost of products dispensed in ATC subgroup P02. Mebendazole was followed by albendazole. Most products (71.36%) dispensed were originator products, with only mebendazole and albendazole having generic equivalents. Dispensing patterns for mebendazole peaked in January and December (traditional holiday months in South Africa). The majority (83.02%) of products for praziquantel were dispensed in the northern provinces of South Africa (Gauteng, Limpopo, KwaZulu-Natal and Mpumalanga). Parents and healthcare workers need to be more aware of possible helminth infections and the cost and availability of generics for albendazole and mebendazole.Keywords: Anthelmintics, mebendazole, albendazole, deworming agents, drug utilisation.

The primary aim was to determine the dispensing patterns of antimalarial medicine in a community pharmacy patient population in South Africa. A retrospective, cross-sectional drug utilisation study was conducted on a 2013 pharmacy database. Medicines reimbursed by private medical aid schemes and private purchases were included. Records for antiprotozoals (ATC group P01) were extracted, with the focus on antimalarials. A total of 140132 antiprotozoal products were dispensed. Most products (67.28%) were for agents against amoebiasis and other protozoal diseases, followed by antimalarials (31.54%). A total of 19121 patients were prescribed 44191 antimalarial products. The average age of patients was 49.81 (SD=15.64) years. Half of the antimalarial products dispensed were for chloroquine (49.39%), followed by mefloquine (19.32%), the combination of atovaquone and proguanil (19.21%) and quinine (11.09%). Other active ingredients were artemether in combination with lumefantrine (386 products), the combination of sulfadoxine and pyrimethamine, halofantrine hydrochloride and pyrimethamine. Most products were prescription-only medicines. There was an increase in the number of products dispensed from July to December, that is, towards the warmer months in South Africa. Gauteng, the Western Cape and KwaZulu-Natal had the highest number of products dispensed. Chloroquine accounted for half of antimalarial medicines. However, chloroquine has dual usage for malaria and rheumatoid arthritis, and the high chloroquine prescribing rate may therefore not only reflect malaria prescriptions. The study provided baseline information on antimalarial dispensing patterns and emphasised the importance of diagnoses in drug utilization research.Keywords: Malaria, antiprotozoal, drug utilisation, prescribing patterns, South Africa