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Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An
Carol A Hitchon1, Girsh M Mody2, Candace H Feldman3
1University of Manitoba, Winnipeg, Manitoba, Canada.
ACR Open Rheumatology
|July 1, 2021
Summary
Methotrexate (MTX) use for rheumatic diseases in Africa faces barriers like inconsistent supply and cost, especially in low-HDI countries. Tailored recommendations are needed to improve patient access and care.
Area of Science:
- Rheumatology
- Pharmacology
- Global Health
Background:
- Current guidelines for methotrexate (MTX) use in rheumatic diseases may not be practical for physicians in less developed nations.
- Understanding the experiences of MTX prescribers in African countries is crucial for developing appropriate recommendations.
Purpose of the Study:
- To explore the challenges and facilitators of methotrexate (MTX) use for rheumatic diseases among African physicians.
- To inform the development of culturally and geographically relevant MTX treatment guidelines for African countries.
Main Methods:
- Semistructured interviews were conducted with African physicians prescribing MTX between August 2016 and September 2017.
- Participants were stratified based on their country's Human Development Index (HDI): low (L-HDI) versus medium or high (MH-HDI).
- Interview transcripts were coded thematically to identify barriers and experiences related to MTX use.
Main Results:
- Key barriers included inconsistent MTX supply (87% L-HDI vs. 43% MH-HDI) and financial restrictions (93% L-HDI vs. 64% MH-HDI).
- Patient hesitancy due to cultural beliefs, limited prescribers, prevalent infections (HIV, viral hepatitis, TB), and monitoring test accessibility/cost were also significant.
- MTX pretreatment evaluation and dosing strategies were comparable between L-HDI and MH-HDI countries.
Conclusions:
- Treating rheumatic diseases in Africa is challenged by unreliable drug availability, cost, limited specialists, and patient beliefs.
- Adapting MTX recommendations for endemic infections, ensuring feasible monitoring, stable drug supply, and specialized care are vital.
- Improving patient education is essential to reduce the burden of rheumatic diseases, particularly in L-HDI countries.
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