Promoting Rational Use of ARVs in HIV/AIDS Clinics in Tanzania

Presented by Salama Mwakisu -MSH

Background and ObjectivesBackground Tanzania has made significant progress in scaling up antiretroviral therapy (ART)

to eligible people living with HIV/AIDS. Over 900 sites provide ART services with 390,320 pts ever on ART However, little is known about current medicines use practices in ART clinics. To understand current medicines use practices in ART clinics and identify areas

needing improvement, the rapid assessment was conducted from February to April 2010

Specific Objectives To assess the current dispensing practices and identify areas needing

improvement. To measure degree to which current prescribing practices conform to the

national guidelines for management of HIV/AIDS. To identify health facility-related factors which could affect medicines use

practices. To assess current practices related to medicines safety monitoring and reporting.

MethodologyDesign: Data collection was done through Document review, observing dispensing encounters, prescriptions review, physical check of medicines availability, and interviews with health workers to understand factors influencing medicines use

practices.

Setting: 51 public and private ART facilities at the district and primary health care levels were selected from 8 districts based on the HIV prevalence rate and on the needs identified by National AIDS Control program and ART partners

Outcome measure(s): % availability of key medicines, % of facilities with selected guidelines available, Conformity to treatment guidelines % of dispensers providing adequate information to patients on how to use

medicines

Results:Staff Involved in Dispensing ARVs

Availability of Guidelines

Availability of HIV Guidelines Versus Initiating Patients on Default 1st line Regimen

Availability of Key HIV&AIDS Related Medicines

Prescribing Practice Non-adherence to treatment guidelines

o Non conformity to default first-line regimen (55%)o Long duration or early discontinuation of CTX prophylaxis

Only 45% of facilities used prescriptions for ARVs

227 Prescription reviewed: 45% had no patients` weight, 23% no age, and 18% no dosage

Use of patient card (CTC1) for dispensing instead of prescriptions

Use of ARV regimen codes ( 1c, 1b, etc). in prescribing in some facilities instead of ARV names.

Implication: greater potential for dispensing errors.

Medication Use Counseling

A total of 245 dispensing encounters were observed

ADR Monitoring and Reporting

Lessons Learnt Limited availability of pharmaceutical professionals managing ART commodities

at facility level is a challenge. Most of pharmacy related supervisory support focus on supply chain issues Availability of ARVs is crucial to ensure patients are maintained in their

respective regimens Availability of treatment guidelines does not guarantee their effective use.

Implication SOPs, job aids, training materials have been developed. Rational medicines use

topics are being integrated into ART and PMTCT pharmaceutical management trainings.

Integrating monitoring of medicine use practices into ART mentoring toolkit is critical.

Empowering facilities to establish internal medicines use monitoring mechanisms is important

Further Research Effect of non adherence to treatment guidelines on ART treatment cost Effect of irrational use on patients treatment outcome