Understanding the widespread use of veterinary ivermectin for Chagas disease, underlying factors and implications for the COVID-19 pandemic: a convergent mixed-methods study.

Autor:	Apodaca Michel B; Department of Medical and Social Projects, DAHW, Würzburg, Germany.; Medical Department, Centro Integral Dermatológico, Monteagudo, Plurinational State of Bolivia., Navarro M; Department of Public Health, Science History and Gynecology, Universidad Miguel Hernández, Alicante, Spain., Pritsch M; Division of Infectious Diseases and Tropical Medicine, University Hospital LMU Munich, Munich, Germany., Du Plessis JD; Department of Mathematics and Applied Mathematics, University of Cape Town, Rondebosch, South Africa., Shock J; Department of Mathematics and Applied Mathematics, University of Cape Town, Rondebosch, South Africa., Schwienhorst-Stich EM; Department of General Practice, University Hospital Würzburg, Würzburg, Germany.; Medical Faculty, University of Würzburg, Würzburg, Germany., Zirkel J; Medical Faculty, University of Würzburg, Würzburg, Germany., Schrader H; Department of General Practice, University Hospital Würzburg, Würzburg, Germany., Saavedra Irala C; Department of Medical and Social Projects, DAHW, Würzburg, Germany.; Medical Department, Centro Integral Dermatológico, Monteagudo, Plurinational State of Bolivia., Rubilar G; Department of Medical and Social Projects, DAHW, Würzburg, Germany., Gunesch C; Department of Medical and Social Projects, DAHW, Würzburg, Germany., Kasang C; Department of Medical and Social Projects, DAHW, Würzburg, Germany., Zoller T; Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Gagyor I; Department of General Practice, University Hospital Würzburg, Würzburg, Germany., Parisi S; Department of Medical and Social Projects, DAHW, Würzburg, Germany Parisi_S@ukw.de.; Department of General Practice, University Hospital Würzburg, Würzburg, Germany.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 Sep 17; Vol. 12 (9), pp. e058572. Date of Electronic Publication: 2022 Sep 17.
DOI:	10.1136/bmjopen-2021-058572
Abstrakt:	Objectives: Veterinary ivermectin (vet-IVM) has been used widely in Latin America against COVID-19, despite the lack of scientific evidence and potential risks. Widespread vet-IVM intake was also discovered against Chagas disease during a study in Bolivia prior to the pandemic. All vet-IVM-related data were extracted to understand this phenomenon, its extent and underlying factors and to discuss potential implications for the current pandemic. Design: A convergent mixed-methods study design including a survey, qualitative in-depth interviews (IDI) and focus group discussions (FGD). Setting: A cross-sectional study conducted in 2018 covering the geographic area of Monteagudo, an endemic municipality for Chagas disease. Participants: A total of 669 adult household representatives from 26 communities participated in the survey, supplemented by 14 IDI and 2 FGD among patients, relatives and key informants. Results: 9 IDI and 2 FGD contained narratives on vet-IVM use against Chagas disease. Five main themes emerged: (1) the extent of the vet-IVM phenomenon, (2) the perception of vet-IVM as a treatment for Chagas disease, (3) the vet-IVM market and the controversial role of stakeholders, (4) concerns about potential adverse events and (5) underlying factors of vet-IVM use against Chagas disease.In quantitative analysis, 28% of participants seropositive for Chagas disease had taken vet-IVM. Factors associated with multivariate analysis were advanced age (OR 17.01, 95 CI 1.24 to 36.55, p=0.027 for age above 60 years), the experience of someone close as information source (OR 3.13, 95 CI 1.62 to 5.02, p<0.001), seropositivity for Chagas disease (OR 3.89, 95 CI 1.39 to 6.20, p=0.005) and citing the unavailability of benznidazole as perceived healthcare barrier (OR 2.3, 95 CI 1.45 to 5.18, p=0.002). Participants with an academic education were less likely to report vet-IVM intake (OR 0.12, 95 CI 0.01 to 0.78, p=0.029). Conclusions: Social determinants of health, the unavailability of treatment and a wonder drug image might contribute to the phenomenon of vet-IVM. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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