title: Factors before enrolment are associated with being removed from a Pharmacy-only Refill Programme at a large urban HIV/AIDS clinic, Uganda.
abstract: A Pharmacy-only Refill Programme (PRP) a type of task shifting in which stable HIV-positive patients are managed through pharmacy-only visits instead of physician visits. We performed a study to identify factors for being removed from the PRP in order to establish better referral criteria. The study was performed at the Infectious Disease Clinic (IDC) in Kampala, Uganda. We selected a random sample of 588 patients from 2431 patients on antiretroviral therapy referred to the PRP at least 12 months before commencement of the PRP evaluation. We compared the characteristics of patients who during 12 months of follow-up were removed from the PRP with those who continued to be followed up. Data were abstracted from the IDC data base, the pharmacy register and the patient clinical notes. Of 588 patients, 106 (18%) were removed from the PRP. In multivariate analysis, less than 100% self-reported adherence to antiretroviral therapy, missing at least one scheduled appointment in the six months before referral to the PRP and being on a lopinavir/ritonavir-containing regimen were independently associated with being removed from the PRP. Criteria for referring patients to a PRP should focus on antiretroviral therapy adherence and appointment keeping. Patients on a lopinavir/ritonavir-containing regimen should not be targeted for a PRP. On the other hand a PRP is an efficient strategy that targets stable adherent patients in clinics with high patient load.
authors: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors: A
authors: A
authors: Nakiwogga-Muwanga
authors: E
authors: E
authors: Katabira
authors: A
authors: A
authors: Kiragga
authors: A
authors: A
authors: Kambugu
authors: E
authors: E
authors: Nakibuuka-Lubwama
authors: Y C
authors: YC
authors: Manabe
authors: S T
authors: ST
authors: Alamo
authors: R
authors: R
authors: Colebunders
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001071:Appointments and Schedules; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006295:Health Resources / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010348:Patient Care Team / Q000458:organization & administration*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010604:Pharmacy; D012017:Referral and Consultation / Q000458:organization & administration*; D012307:Risk Factors; D014454:Uganda; D014505:Urban Population; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; HIV; Pharmacy-only Refill Programme; Uganda; adherence; antiretroviral therapy; human resources; pharmacy; resource-limited setting; stable patients; task shifting; treatment; urban care