Promoting Rational Use of ARVs in HIV/AIDS Clinics in Tanzania Presented by Salama Mwakisu -MSH

Background and Objectives Background  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.

Methodology Design: 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 1 st 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 (CTC 1 ) 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