Strategies and interventions to strengthen pharmacovigilance systems in low- and middle-income countries: a scoping review.

IntroductionIn the past decades, numerous strategies have been proposed to strengthen pharmacovigilance (PV) systems in low-and-middle-income countries (LMIC). Though there has been progress, many PV systems in LMIC are still not performing adequately. The objectives of this scoping review are to describe strategies to strengthen PV in LMIC and to propose recommendations for future investments in capacity building. MethodsThe review was conducted following the Joanna Briggs Institute (JBI) guidelines on conducting scoping reviews. Literature searches were performed in MEDLINE, EMBASE, Web of Science, PDQ-evidence, CINAHL and relevant websites from 1990 to January 2021. Publications included were primary studies, articles, and policy and guideline papers, describing interventions to strengthen PV in LMIC. Two reviewers independently screened titles, abstracts and full-texts, and one reviewer performed data extraction and carried out a descriptive data analysis. Results10,903 unique titles were screened and 152 were eligible for full text review. Of these, 57 and an additional 13 reports from grey literature fulfilled eligibility criteria for inclusion in the review. Forty-five papers (64%) described interventions aimed at increasing PV knowledge and reporting of adverse drug reactions (ADR), primarily education of healthcare professionals (HCP), alone or in combination with other interventions such as mobile and electronic reporting, enhanced passive and active surveillance. Twenty-five papers (36%) discussed interventions or strategies implemented at the national targeting different components of the national PV system, such as legal basis and guidelines for PV, PV organisation and infrastructure and PV procedures. ConclusionsResults of this review suggest that educating HCP on ADR reporting is the most common approach to build PV capacity in LMIC. Though important, education alone is insufficient and should ideally be organised within the holistic framework of strengthening national PV systems, with a focus on building capacity for advanced activities such as signal detection. Key messageThere are numerous strategies and recommendations to strengthen PV systems in LMIC. However, the effective implementation of these strategies has not been extensively described in literature. This scoping review describes different interventions and strategies that have been implemented to build and improve PV capacity in systems in LMIC. An overview of current PV strengthening strategies and interventions, and when available, their outcome and impact, is useful to guide decision making for future investments in PV development in developing countries. Trial registrationOpen Science Framework (https://osf.io/ge56p)