1. KENYATTA NATIONAL HOSPITAL

2. PROMOTING RATIONAL USE OF ANTI-RETROVIRALS (ARV) AT KENYATTA NATIONAL HOSPITAL (KNH) IN KENYA BY OGILE ELIZABETH BPharm Pg Cert EDM & RDU MPSK

3. Authorized Establishment -6,212In-post -5,225 KNH has a total of 9 pharmacies

4. INTRODUCTION AND PROBLEM STATEMENT  HIV/AIDS has been viewed to affect productivity of workers and also to increase health treatment cost. KNH also faced a similar problem. ( Ref Kenya HIV/AIDS business Council Report ).  In Feb1998 the KNH management decided to avail free ARV treatment to staffs as non – scheduled/ Extraformulary drug.  In June 1999, the situation was getting out of hand.  There were no clear guidelines for prescribing and dispensing the ARVs.  There were no proper records. Staff collected drugs from any pharmacy. The buying and supply of ARV was very erratic.  Further investigations revealed that ARV prescribing was from other sources, not specialists only. A number of prescriptions were not genuine. There was no monitoring and follow up on the genuine patients.  Frequent stock out periods.

5.  The hospital management mandated the Medical Advisory Committee ( MAC) to review the situation and then make recommendations.

6. OVERALL GOAL  MAC came up with the following policy interventions to be implemented at prescribing and pharmacy levels.

7. SETTING AND POPULATION  Kenyatta National Hospital.  Staffs diagnosed to be HIV/AIDS positive and presented with prescriptions in the pharmacy ( about 100 patients )

8. INTERVENTIONS ( MARCH 2000 )  MAC recommendations were implemented at prescribing and dispensing level. PRESCRIBING  Limiting prescribing to only 3 appropriately trained clinical specialists and ensuring that each patient had a specific file opened.  The staffs had to take their prescriptions for countersigning by the Deputy CEO ( Clinical Service ) for verification.

9. INTERVENTION The following procedures were implemented:-  The hospital management decided that prescribing of ARVs be limited to only 3 appropriately trained clinical specialists and based on hospital approved treatment schedules.  Introducing a requirement that authority must be sought from deputy Chief Executive Officer (clinical services) before a prescription is dispensed.

10. INTERVENTION…. CONTD DISPENSING  Dispensing was centralized to one pharmacy.  The dispensers ensured that prescriptions were countersigned and also had the recommended combinations.  Patients were required to purchase an item out of stock and bring to the pharmacy to receive available drugs ( Provision for reimbursement ).  Computerized record keeping system was introduced in the pharmacy.  ARV monitoring form was introduced in march 2001.

11. RESULTS  Preliminary results show that 16% of the ARV prescriptions as at June 1999 were not genuine ( not real patients ).  The situation as at March 2001 show that there was still about 2% of ungenuine prescriptions.  We have created a database for monitoring ARV therapy and for controls.

12. KENYATTA NATIONAL HOSPITAL ARV THERAPY MONITORING FORM Personal Details Patient Number: Patient Name:Gender: Address:Age: Tel:Weight: E-mail:BSA: Clinical Parameters CD4 count Viral Load Date

13. Reg. No. CombinationStartDateStopDateDuration Reason for stopping ComplianceToxicity Antiretroviral Therapy

14. Dispensing DrugQuantityPharmacistDateCollected Next Supply Date

15. LESSON LEARNT  It is difficult to manage ARV treatment of staffs by staffs.  Simple policy interventions can be used effectively to promote Rational ARVS usage. BUT …….. The patients were getting tired ( complaining ).

16. CONCLUSION  Comprehensive care unit was set in October 2002  Comprehensive care unit ( CCU ) borrowed the concepts of the policy interventions.  In April 2003 the staffs HIV/AIDS management programme was intergrated into CCU program.