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Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Authors :
Carol A. Hitchon
Girsh M. Mody
Candace H. Feldman
Yan Lau
Steven Shi
Michele Meltzer
Rosie Scuccimarri
Michael E. Weinblatt
Ines Colmegna
Source :
ACR Open Rheumatology, Vol 3, Iss 8, Pp 522-530 (2021)
Publication Year :
2021
Publisher :
Wiley, 2021.

Abstract

Objective Guidelines for methotrexate (MTX) use in rheumatic disease may not be feasible for physicians practicing in the least developed countries. We aimed to understand the experiences of MTX prescribers relating to MTX use for rheumatic disease in African countries to inform the development of culturally and geographically appropriate recommendations. Methods African physicians who self‐identified as MTX prescribers from countries classified as having a low versus a medium or high Human Development Index (L‐HDI versus MH‐HDI) participated in semistructured interviews between August 2016 and September 2017. Interviews were transcribed verbatim, coded thematically, and stratified by HDI. Results Physicians (23 rheumatologists; six internists) from 29 African countries were interviewed (15 L‐HDI; 14 MH‐HDI). Identified barriers to MTX use included inconsistent MTX supply (reported by 87% L‐HDI versus 43% MH‐HDI), compounded by financial restrictions (reported by 93% L‐HDI versus 64% MH‐HDI), patient hesitancy based partly on cultural beliefs and societal roles (reported by 71%), few prescribers (reported by 33%), prevalent infections (especially viral hepatitis, tuberculosis, and human immunodeficiency virus), and both availability and cost of monitoring tests. MTX pretreatment evaluation and starting and maximal doses were similar between L‐HDI countries and MH‐HDI countries. Conclusion The challenges of treating rheumatic disease in African countries include unreliable drug availability and cost, limited subspecialists, and patient beliefs. Adapting recommendations for MTX use in the context of prevalent endemic infections; ensuring safe but feasible MTX monitoring strategies, enhanced access to stable drug supply, and specialized rheumatology care; and improving patient education are key to reducing the burden of rheumatic diseases in L‐HDI countries.

Details

Language :
English
ISSN :
25785745
Volume :
3
Issue :
8
Database :
Directory of Open Access Journals
Journal :
ACR Open Rheumatology
Publication Type :
Academic Journal
Accession number :
edsdoj.0342a310fbaa4ddb981c2865e86de393
Document Type :
article
Full Text :
https://doi.org/10.1002/acr2.11290