Andrew Gray

Andrew Gray
University of KwaZulu-Natal | ukzn · Discipline of Pharmaceutical Sciences

MSc(Pharm)

About

127
Publications
21,686
Reads
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3,234
Citations
Additional affiliations
February 2002 - present
University of KwaZulu-Natal
Position
  • Consultant pharmacist
Education
January 1983 - June 1984
Rhodes University
Field of study
  • Physiology, Immunology
February 1978 - November 1981
Rhodes University
Field of study
  • Pharmacy

Publications

Publications (127)
Article
We know little about the safety or efficacy of pharmacological medicines for children and adolescents with chronic pain, despite their common use. Our aim was to conduct an overview review of systematic reviews of pharmacological interventions that purport to reduce pain in children with chronic non-cancer pain or chronic cancer-related pain. We se...
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This chapter has focused on the extent to which South Africa is, with current health financing arrangements, managing to meet the demands of universal health coverage (UHC). One way to measure this is through calculation of the UHC service coverage index. On that basis, South Africa is currently assigned an index of 67, marginally above the global...
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Transparency is a salutary value in South Africa (SA)’s constitutional architecture. It has also been described as a necessary element in promoting accountability in the regulatory aspects of essential medicines. Nevertheless, despite its several incarnations since its promulgation, the Medicines and Related Substances Act No. 101 of 1965 retains a...
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It has now been 20 years since the National Drug Policy (NDP) was published in 1996. This was one of the earliest comprehensive policy documents issued by the first post-apartheid Department of Health, and was subsequently included as an appendix to the 1997 White Paper on the Transformation of the Health System in South Africa. The NDP was develop...
Article
Background: Pain is a common feature of childhood and adolescence around the world, and for many young people, that pain is chronic. The World Health Organization guidelines for pharmacological treatments for children's persisting pain acknowledge that pain in children is a major public health concern of high significance in most parts of the worl...
Article
Background: Pain is a common feature of childhood and adolescence around the world, and for many young people, that pain is chronic. The World Health Organization (WHO) guidelines for pharmacological treatments for children's persisting pain acknowledge that pain in children is a major public health concern of high significance in most parts of th...
Chapter
South Africa has implemented a number of important medicine policies in the post-apartheid era, informed by the 1996 National Drug Policy. Despite considerable resistance, firstly from the transnational pharmaceutical industry but later from a wider range of stakeholders, a number of legal reforms have been successfully implemented. In the public s...
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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the analgesic efficacy, and adverse events, of opioids used to treat cancer pain in children and adolescents between birth and 17 years, in any setting. © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Article
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the analgesic efficacy, and adverse events, of opioids used to treat chronic non-cancer pain in children and adolescents aged between birth and 17 years, in any setting. © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Article
Objective: To assess the impact of mandatory offer of generic substitution, introduced in South Africa in May 2003, on private sector sales of generic and originator medicines for chronic diseases. Methods: Private sector sales data (June 2001 to May 2005) were obtained from IMS Health for proton pump inhibitors (PPIs; ATC code A02BC), HMG CoA r...
Article
Despite the availability of medicines with proven efficacy, many patients use complementary or alternative medicines (CAMs) to manage atopic eczema (AE). Due to the lack of objective information on topical CAMs, this systematic review (SR) evaluates current evidence of efficacy and safety of topical herbal preparations in AE. Using Cochrane SR meth...
Chapter
South Africa has implemented a number of important medicine pricing interventions in the post-apartheid era, informed by the 1996 National Drug Policy. Despite considerable resistance, firstly from the transnational pharmaceutical industry but later from a wider range of stakeholders, a number of legal reforms have been successfully implemented. Ho...
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Background: Low- and middle-income countries (LMICs) rely on available evidence when devising and implementing pharmaceutical policies. Aim of the review To provide a critical overview of systematic reviews of pharmaceutical policies, with particular focus on the relevance of such reviews in low- and middle-income countries. Methods: A search fo...
Article
Initiation of antiretroviral therapy (ART) during tuberculosis (TB) treatment improves survival in TB-HIV coinfected patients. In patients with CD4 counts <50 cells per cubic millimeter, there is a substantial clinical and survival benefit of early ART initiation. The purpose of this study was to assess the costs and cost-effectiveness of starting...
Article
I consider it a signal honor to receive the Donald E. Francke Medal today, and I wish to record my gratitude to the board of directors of the American Society of Health-System Pharmacists, who approved the award. Unlike the majority of the previous recipients of this prestigious award, I did not
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Aim: The aim of this study was to compare the costs of management of moderate to severe infections in patients treated with imipenem/cilastatin (IC) and meropenem (MEM). Pharmacoeconomic studies in Saudi Arabia are scarce. The current hospital formulary contains 2 carbapenems: IC and MEM. These antibiotics share a similar spectrum of activity. The...
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Frequency of drug changes in combination antiretroviral therapy among patients starting both tuberculosis (TB) and human immunodeficiency virus (HIV) therapy, as a result of treatment-limiting toxicity or virological failure, is not well established. Patients in the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPiT) trial were...
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The most obvious change introduced by the WHO Guidelines for the Pharmacological Treatment of Persisting Pain in Children with Medical Illness, issued in 2012, is the advocacy of a two-step rather than three-step pain 'ladder'. The guideline states that paracetamol and ibuprofen are the medicines of choice in the first step (for mild pain), and tha...
Chapter
As a leading economy on the African continent, but also the country most affected by HIV/AIDS and a high-burden tuberculosis country, South Africa has often been seen as a particularly important case study for access to medicines issues. The country has both an established generic medicines manufacturing industry and a notable presence of transnati...
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In a South African context, we consider the implications of the United States Food and Drug Administration's recent approval of the OraQuick HIV self-testing kit. We argue that current law and policy inhibit the roll-out of accurate and well-regulated self-testing kits, and create a loophole for sale in supermarkets, but not pharmacies. S Afr J HIV...
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In a South African context, we consider the implications of the United States Food and Drug Administration’s recent approval of the OraQuick HIV self-testing kit. We argue that current law and policy inhibit the roll-out of accurate and well-regulated self-testing kits, and create a loophole for sale in supermarkets, but not pharmacies.
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Full-text available
In a South African context, we consider the implications of the United States Food and Drug Administration’s recent approval of the OraQuick HIV self-testing kit. We argue that current law and policy inhibit the roll-out of accurate and well-regulated self-testing kits, and create a loophole for sale in supermarkets, but not pharmacies.
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Background: Asthma is one of the most common chronic respiratory conditions affecting young children. It is estimated that asthma affects 20% of schoolchildren in South Africa. The school setting represents “home” for most children, and teachers are recognised as in loco parentis. Therefore, it is imperative that primary school teachers have suffic...
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6,7 A recent commentary in a Belgian pharmacy journal claims that the problem is global – “from Afghanistan to Zimbabwe” – listing 21 countries affected by a variety of supply problems. 8 A shortage of the injectable antibiotic streptomycin was reported in 15 countries in 2010, with 11 more countries predicting their stocks would run out before the...
Article
The 18th Meeting of the WHO Expert Committee on the Selection and Use of Essential Medicines took place in Accra, Ghana on 21-25 March 2011. This was the first meeting of the Committee held outside of Geneva. The purpose of the meeting was to review and update the WHO Model List of Essential Medicines (EML) as well as the WHO Model List of Essentia...
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Drug interactions are of concern when treating patients co-infected with human immunodeficiency virus (HIV) and tuberculosis. Concomitant use of efavirenz (EFV) with the enzyme inducer rifampicin might be expected to increase EFV clearance. We investigated the influence of concomitant tuberculosis treatment on the plasma clearance of EFV. Fifty-eig...
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We previously reported that integrating antiretroviral therapy (ART) with tuberculosis treatment reduces mortality. However, the timing for the initiation of ART during tuberculosis treatment remains unresolved. We conducted a three-group, open-label, randomized, controlled trial in South Africa involving 642 ambulatory patients, all with tuberculo...
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Introduction: Integrating HIV and tuberculosis (TB) treatment can reduce mortality substantially. Practical barriers to treatment integration still exist and include safety concerns related to concomitant drug use because of drug interactions and additive toxicities. Altered therapeutic concentrations may influence the chances of treatment success...
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The WHO has undertaken an update of the 1998 WHO Cancer Pain Relief and Palliative Care in Children Guidelines, in extending the scope to persisting pain associated with other medical conditions. The new WHO Guidelines for Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses, using the GRADE approach for evidence synthesi...
Chapter
Access to uninterrupted supplies of suitably selected, affordable essential medicines are critical to the management of chronic, non-communicable diseases. Selection of these medicines requires consideration of evidence of efficacy and safety by multi-disciplinary teams, with due consideration of the potential impact of conflicts of interest. Ensur...
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To investigate the feasibility of surveillance of antimicrobial use in the community in resource-constrained settings. Overuse and misuse of antimicrobial medicines is contributing to the development of resistance. The WHO Global Strategy for Containment of Antimicrobial Resistance recommends surveillance of use at all levels of the health sector b...
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The rapid increase in antimicrobial resistance (AMR) among bacteria is a major public health concern. The WHO Global Strategy for Containment of Antimicrobial Resistance proposed that model systems be developed for AMR surveillance and for monitoring antimicrobial use. Pilot projects were established in three sites in India and two in South Africa...
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Boulle et al. queried whether a clinical trial was needed to provide the evidence for the mortality benefits of antiretroviral therapy (ART) initiation during tuberculosis (TB) treatment. While several experts, including foremost TB-HIV scientists from South Africa and the USA, senior World Health Organization (WHO) and UNAIDS officials at the time...
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Self-tests for HIV in South Africa are currently unregulated. Gaps in law and policy have created a legal loophole where such tests could effectively be sold in supermarkets, but not in pharmacies. At the same time, South Africa lacks an effective regulating mechanism for diagnostic tests, which brings the quality and reliability of all self- tests...
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The rates of death are high among patients with coinfection with tuberculosis and the human immunodeficiency virus (HIV). The optimal timing for the initiation of antiretroviral therapy in relation to tuberculosis therapy remains controversial. In an open-label, randomized, controlled trial in Durban, South Africa, we assigned 642 patients with bot...
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Pediatric pharmacotherapy in Africa is constrained by a variety of factors, not all of them unique to the continent. While affordability of medicines and the availability of sustainable financing for healthcare are constant challenges to African health systems, other issues of particular importance for pediatric care are also hampering access. Thes...
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Background: Pharmaceutical advertising, in a variety of forms, has been shown to influence prescribing behaviour. Regulatory systems have therefore been concerned with the quality of advertising and compliance with either imposed or self-regulatory codes of practice. Although the South African Medicines Act provides for an enforceable code of pract...
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Background: South Africa has followed a pro-generic policy since the introduction of the National Drug Policy in 1996. The selection processes in the public and private sectors have, however, remained largely disconnected, and at times contradictory. Medicines provided outside of hospitals accounted for 17% of medical aid spend in 2006, up 8.8% fro...
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On 19 November 2003, the South African Cabinet approved the 'Operational Plan for Comprehensive Treatment and Care for HIV and AIDS'. After years of international protest, court action and unnecessary deaths, the South African government committed itself to a plan 'that provide[d] for Anti-retroviral Treatment in the public health sector. Many acti...
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Background: The release of the results of the oestrogen plus progesterone therapy (EPT) arm of the Women's Health Initiative (WHI) in July 2002 started a worldwide process of reconsideration of the rationale behind hormone therapy (HT). This process was accelerated after the release of the results from the oestrogen-only (ET) arm of the same study....
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Jerome Singh and colleagues present the ethical and legal challenges surrounding the enrollment of adolescents in HIV observational studies and other types of sensitive research.
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Tuberculosis is the most common serious opportunistic infection associated with HIV infection in sub-Saharan Africa and a strong case has been made for integrating tuberculosis and HIV care. In those settings where the tuberculosis and HIV epidemics converge existing tuberculosis programmes provide an opportunity for efficiently identifying those H...
Chapter
THE MEDICINE MANAGEMENT CYCLE is an essential component when considering implementation of antiretroviral treatment in South Africa. This is traditionally portrayed as a cycle in which choosing medicines must be followed by procurement, distribution and use. These processes must be used to learn from each cycle and ensure its continuation. The disc...
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Objective To quantify the extent of potentially inappropriate prescribing among elderly patients seen at public sector primary health care facilities and old age homes in a South African urban setting. Method Cross-sectional survey of the prescription charts of patients aged 65 years or older, using a list of potentially inappropriate medicines in...
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This postscript to the Quality Use of Medicines series of reviews will look back at the principles put forward in the first article, while considering how these should be deployed by the family practitioner in the current practice milieu.1 The articles in the series have tried to convey how the application of evidence can promote the "therapeutical...
Article
The first WHO essential drugs list, published in 1977, was described as a peaceful revolution in international public health. The list helped to establish the principle that some medicines were more useful than others and that essential medicines were often inaccessible to many populations. Since then, the essential medicines list (EML) has increas...
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Acne is an oft-encountered presentation in family practice, and while sometimes downplayed as essentially a cosmetic and self-limiting problem, it is nonetheless associated widi a definite risk of scarring, both physically and emotionally. This paper uses the P-drug approach, as outlined in the WHO Guide to Good Prescribing, to describe a rational...
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Infectious diseases pose quite different challenges to those who seek to apply evidence-based guidelines, as they do to managers of Essential Medicines programmes. The first challenge is that of resistance - unlike the causes of non- infectious conditions, microbes can develop resistance to antimicrobials over time. This may render yesterday's guid...