Antifungal Policy and Practice Across Five Countries: A Qualitative Review

Abstract

The burden of invasive fungal infections (IFIs) is increasing worldwide. National, regional, and local policies on IFI management should respond to the changing landscape. We assessed antifungal policies from five countries of varying size, IFI burden, and geography: the Netherlands, Italy, South Korea, China, and India. These countries were selected as a representative sample reflecting different types of economic and health systems that patients and providers access worldwide. This assessment focused on a comprehensive range of antifungal policy elements, including recognition and prioritization, awareness and education, prevention and monitoring, diagnosis and coordinated care, access to appropriate treatment, and diagnostic and treatment innovation. Although countries in this analysis all have some form of policy for IFI management, we have identified substantial gaps, including low prioritization of IFI diagnostics, omission of fungal pathogens from antimicrobial resistance policies, and a general lack of awareness and healthcare professional (HCP) training on IFI management. The gaps identified are intended to inform HCPs and policy- and decision-makers about aspects to consider in reducing the IFI burden for patients and health systems while demonstrating responsible antifungal stewardship.

Keywords: education; invasive fungal infections; policy; stewardship; surveillance.

Figure 1

Framework of policy analysis (AMR—antimicrobial resistance; HCP—healthcare provider; R&D—research and development).

Figure 2

Summary of research findings. Green indicates established policies/initiatives AND/OR evidence of policy/initiative implementation. Yellow indicates that policies/initiatives exist but are limited in scope or timeframe, OR there is a lack of policies/programs currently but evidence of future developments. Red indicates a scarcity of current and future policies/initiatives.