MedMinas project: design and use of mixed methods in the evaluation of pharmaceutical services in primary health care in Minas Gerais, Brazil.

BACKGROUND: The main purposes of primary care-based pharmaceutical services (PHCPS) in Brazil are to provide free access to medicines and pharmaceutical care to patients. Several obstacles hinder achieving their goals; thus, MedMinas Project aimed to evaluate the PHCPS, the supply system, and the use of medicines. This paper reflects on our experience designing, planning, and conducting the project, describing the issues yielded in the field and lessons learned. METHODS: This work consists of a mixed-methods study conducted in Minas Gerais, Southeastern Brazil. We adopted the principles of Rapid Evaluation Methods, employing a multistage stratified sampling for the quantitative and a purposeful sampling for the qualitative components, respectively, and a documentary research. Data sources included individuals (patients and professionals), prescriptions, dispensed medicines, and policy documents collected between April and October 2019. The quantitative data described in this paper were analysed by descriptive statistics and the qualitative by Thematic Content Analysis. RESULTS: A total of 26 municipalities varying from 37,784 to 409,341 inhabitants were included. The field team spent, on average, 16 days in each location. We interviewed 1019 respondents, of which 127 were professionals and 892 patients. The participation rate varied from 92 to 100%, depending on the respondent subgroup. Most interviews lasted between 45 min and one hour. Fieldwork challenges included participants' enrolment, field team, interview processes, and project budget. The participants provided positive feedback and five main themes emerged from the interview experience (self-awareness, sense of gratitude, research value, access to findings, and benefits of the research). Additionally, we collected copies of 1072 documents and 2070 pieces of data from prescriptions filled and medicines dispensed at the PCP. CONCLUSION: We demonstrated the viability of conducting the MedMinas Project in an extensive geographic area within effective time frames that provided meaningful, high-quality data from multiple actors. The methods and lessons learned are valuable for researchers across various disciplines in similar urban settings in Brazil and other countries of low- and middle-income (LMIC).

Strategic analysis of tuberculosis prevention and control actions in Brazil and Ethiopia: one size fits all?

OBJECTIVES: This study aimed at conducting a strategic analysis of Tuberculosis prevention and control actions in Brazil and Ethiopia, looking at the potential of directly observed treatment short-course strategy (DOTS) and community DOTS in both countries. METHODS: Literature review was conducted using PubMed, Medline-Ovid, EMBASE, and SCIELO databases. The reviewed terms were Tuberculosis, prevention and control and Brazil (or Brasil) or Ethiopia (or Etiopia). Study's eligibility included article's title or abstract in English or Portuguese and comprised the following Tuberculosis policy components: management; care; communication, and social mobilization; training and professional development; epidemiological surveillance, and monitoring and evaluation. The study identified, compared, and analyzed the challenges and recommendations reported in the literature. RESULTS: Although DOTS was not able to address all the difficulties regarding Tuberculosis control and prevention, it contributes to overcome challenges identified in the literature review. Decentralizing DOTS in Ethiopia and implementing DOTS in Brazil were key recommendations to overcome problems of access and treatment default. CONCLUSIONS: DOTS and Community DOTS cannot solve every identified Tuberculosis challenge, but together they complement each other. Both strategies need to be tailored to site's challenges.

[Building evaluation criteria: experts and user satisfaction with pharmaceutical delivery services for HIV/Aids]. / Construindo Critérios de Julgamento em Avaliação: especialistas e satisfação dos usuários com a dispensação do tratamento do HIV/Aids.

A criterion is a typical tool in the evaluation field that can be defined as a standard-dimension under which the object of an evaluation receives qualitative or quantitative judgments. During an evaluation, several rigorous methodological procedures are involved in development and application of suitable criteria to determine the value of the object being evaluated. This article presents a set of criteria to evaluate user satisfaction with HIV/Aids-related pharmaceutical delivery services. The criteria construction process involved consensus amongst different experts, from academia, NGOs, management, by means of the Delphi technique. This technique prescribes a series of formal steps towards a consensus of experts, based on pre-structured methodology and processes. The findings were systematically organized in a structure under which the resulting satisfaction criteria are hierarchically organized. Results suggest the importance of developing a methodological strategy in evaluation that involves participation of different actors and of enhancing knowledge on user satisfaction and pharmaceutical delivery services for HIV/Aids.

[Evaluation of breastfeeding support: meanings from mothers receiving care at primary health care units in the State of Rio de Janeiro]. / Avaliação do apoio recebido para amamentar: significados de mulheres usuárias de unidades básicas de saúde do Estado do Rio de Janeiro.

This article aims at understanding the meanings expressed by women concerning the breastfeeding support received at primary health care (PHC) units. A study was conducted in 24 PHC units in the State of Rio de Janeiro for the purpose of investigating why pregnant women and mothers felt supported (or not) by these units regarding breastfeeding. Heidegger's phenomenological approach was used to develop five structures of meaning, evincing the breastfeeding support provided as "none", "dubious", "incentive", "guidance", and "partnership". When the mothers were asked for suggestions about how the unit could help them breastfeed, their answers generated a new structure of meaning: "continuous support". Some women gave no suggestions, stating that they had none or were satisfied with the support provided. The women indicated possibilities for care based on the singularity of the clientele and on the authenticity of the health-care staff/user relationship. In that process, solicitude needs to be incorporated into the practice of PHC units, so that they can be an effective space for breastfeeding promotion, protection, and support.

Evaluation of STD/AIDS prevention programs: a review of approaches and methodologies.

The article presents a review of approaches and methodologies in the evaluation of STD/AIDS prevention programs, searching for theoretical and methodological support for the institutionalization of evaluation and decision-making. The review included the MEDLINE, SciELO, and ISI Web of Science databases and other sources like textbooks and congress abstracts from 1990 to 2005, with the key words: "evaluation", "programs", "prevention", "STD/AIDS", and similar terms. The papers showed a predominance of quantitative outcome or impact evaluative studies with an experimental or quasi-experimental design. The main use of evaluation is accountability, although knowledge output and program improvement were also identified in the studies. Only a few evaluative studies contemplate process evaluation and its relationship to the contexts. The review aimed to contribute to the debate on STD/AIDS, which requires more effective, consistent, and sustainable decisions in the field of prevention.

Development and validation of a HPLC-UV method for the determination in didanosine tablets.

A simple, rapid, sensitive and specific reversed-phase high performance liquid chromatographic method involving ultraviolet detection (HPLC-UV) was developed for analysis of didanosine in drug substance and formulated products, tablets. Chromatography was carried out on a pre-packed, Lichrospher 100 Rp-8 (5.0 microm, 250 mm x 4.0 mm) column using 0.01 M sodium acetate solution:methanol (85:15, v/v) adjusted to pH 6.5 with acetic acid as mobile phase at a flow rate of 1.5 ml/min and a 248 nm detection. Hypoxantine was confirmed as the main degradation product. The assay was linear over the concentration range of 50-150 microg/ml (R approximately 0.999). The method was validated for accuracy and precision.

[Strengths and limitations of the Rio de Janeiro Municipal AIDS Information System as an instrument for epidemiological surveillance]. / O sistema de informação de AIDS do Município do Rio de Janeiro: suas limitações e potencialidades enquanto instrumento da vigilância epidemiológica.

This study analyzes the Rio de Janeiro Municipal AIDS Information System, specifically the system's strengths and limitations in the epidemic's current context, from a broader perspective of epidemiological surveillance. The objective was to provide a brief description of the system, considering its different components. The authors further analyzed records pertaining to the reporting and investigation of AIDS cases from 1985 to 1995 and an update of the database as a contribution to the system's quality. The results showed improvement in the consistency of the AIDS database, particularly for the following variables: occupation, neighborhood, school, and exposure category, although the study found concrete limitations in the system's design and structure for dealing with the complexity and heterogeneity of AIDS surveillance. The study thus identified the need to construct an efficient HIV/AIDS surveillance system, based on epidemiological indicators aimed at monitoring and evaluating changes in the epidemiological pattern and analysis of the impact on morbidity and mortality resulting from access to more efficient forms of prevention and new treatments.