1. Justine Mirembe MD, MPH ICASA, 5th December 2011
Predictors of Switching Antiretroviral Regimen Among Clients Attending TASO Jinja, Uganda
Justine Mirembe
MD, MPH
ICASA, 5th December 2011

2. Background & objective
The Uganda Ministry of Health recommends AZT/3TC or TDF/3TC or TDF/FTC or D4T/3TC + NVP or EFV as first line antiretroviral drug combinations for treatment of HIV
The predictors of switching antiretroviral drug combinations among clients attending The AIDS Support Organisation (TASO) Jinja centre were assessed in August-December 2008

3. Methods: setting & enrollment
TASO, Jinja Centre
A computer generated sample of 328 active clients was selected
Selected records were retrieved & reviewed
Primary outcome measure was switching ART regimen

4. Proportion of clients by WHO clinical stage
Results (I)
Proportion of clients by WHO clinical stage
1st line ART combination
n(%)
AZT, 3TC, NVP
142 (43.6%)
d4T, 3TC, NVP
132 (40.4%)
d4T, 3TC, EFV
26 (8.0%)
AZT, 3TC, EFV
24 (7.4%)
TDF, 3TC, NVP
2 (0.6%)
Clients by 1st-line ART combinations
150(46.0%) received drugs under home-based model
325 (99.7%) clients were on first-line ART
Switching was effected by clinicians (48; 14.3%), pharmacy technicians (1; 0.3%), nurses (3, 0.9%), or field officers (5, 1.8%).

5. Results (II) Proportion of clients switching ARVs
Switching effected by clinicians (48; 14.3%), pharmacy technicians (1; 0.3%), nurses (3, 0.9%), or field officers (5, 1.8%)
Proportion of clients switching ARVs
ART combination client was started on (d4T/3TC/NVP; p= 0.002), development of side effects (p< 0.001), & lack of treatment supporter (p=0.039) were associated with switching antiretroviral drugs

6. Lessons learned
In some cases, switching of ARVs is not based on guidelines
Further, there are factors outside the policy guidelines that influence switching of ARVs
To control the use of ARVs and to improve on good clinical practice, the collective decision-making process by all ART team members for every client requiring drug replacement should be enforced, and there is need to consider other factors outside the policy guidelines while making the decision.

7. Thank you