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Mapping Therapeutic Drug Monitoring Research in Low- and Middle-Income Countries: A Scoping Review (2015-2024)
Ronaldo Morales Junior1, João P Telles2, Nathalie G S Chua3
1Hospital Sírio-Libanês, São Paulo, Brazil.
Therapeutic Drug Monitoring
|July 15, 2026
Summary
Therapeutic drug monitoring (TDM) research in low- and middle-income countries (LMICs) has grown but is geographically concentrated. Gaps exist in pharmacogenetics and implementation science, requiring improved infrastructure and collaboration for precision medicine.
Area of Science:
- Pharmacology and Clinical Pharmacy
- Global Health Research
- Health Services Research
Background:
- Therapeutic drug monitoring (TDM) is crucial for optimizing drug therapy.
- Research activity in TDM within low- and middle-income countries (LMICs) is not well understood.
- This study systematically reviews TDM research in LMICs from 2015-2024.
Purpose of the Study:
- To map the volume, characteristics, and geographic distribution of TDM research in LMICs.
- To identify trends and gaps in TDM research output from LMICs.
- To inform strategies for advancing precision medicine in resource-limited settings.
Main Methods:
- A systematic scoping review of TDM studies conducted in LMICs.
- Searches were performed in PubMed, Embase, and Web of Science databases.
- Data extracted included publication characteristics, study design, geographic focus, drug classes, and analytical methods.
Main Results:
- 385 publications from 38 LMICs were identified, with a steady increase in annual output.
- The Western Pacific Region dominated, with China as the leading contributor.
- Antimicrobials, immunosuppressants, antiseizure, and antipsychotic drugs were most studied; vancomycin and tacrolimus were most frequent.
Conclusions:
- TDM research in LMICs has expanded but is geographically concentrated and focused on drugs with available commercial assays.
- Significant gaps exist in pharmacogenetics, implementation science, and guideline development for TDM in LMICs.
- Enhancing laboratory infrastructure, fostering equitable international collaboration, and developing locally relevant TDM strategies are essential for advancing precision medicine.
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