Improving HIV Treatment Adherence through a Public Private Partnership in Zambia


Background: Effective ART with low viral loads and absence of STIs significantly reduce chances of sexual transmission of HIV. ART is therefore a key pillar in HIV prevention. Appropriate support is however essential for optimum treatment outcome, patient safety and HIV prevention benefit. The scale-up of ART continues to strain the already overstretched human resources in public facilities, impacts on the quality of care, and contributes to loss to follow-up. Task shifting is therefore a strategy to augment the limited human resources. Methodology: In partnership with the Livingstone General Hospital (LGH) and four private pharmacists, the COH III Project through Howard University is promoting quality HIV care by engaging the pharmacists in adherence counselling and treatment monitoring. The LGH ART pharmacist allocates consenting stable ART clients to pharmacies based on willingness to be referred and patient preference. Patients are given schedule of visits to pharmacies where the pharmacists provide medication/adherence counselling and monitor side effects. Patients with medication/treatment issues are referred back to the LGH ART clinic for follow-up. Results: Between October 2012 and August 2013, 280 patients were enrolled and followed up by the four pharmacists. 69% of patients visited the pharmacy at least once, 25% at least twice and 13% at least thrice. The 33 client referrals by pharmacists to LGH were related to adverse drug reactions, suspected treatment failure, pregnancy, and treatment monitoring. The intervention has reduced workload for the ART pharmacist; improved communication of treatment challenges and identification of patients with medication related problems, and reduced travel distances and waiting times. This has resulted in improved adherence and better patient outcomes. Conclusion: Private pharmacists present an opportunity to improve quality of HIV interventions in poor human resource capacity settings. The necessary legal and regulatory framework needs to however be developed to guide the process.

Share and Cite:

Fomundam, H. , Maranga, A. , Kamanga, J. , Tesfay, A. , Choola, T. , Nyangu, S. and Wutoh, A. (2014) Improving HIV Treatment Adherence through a Public Private Partnership in Zambia. World Journal of AIDS, 4, 107-117. doi: 10.4236/wja.2014.41014.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Central Statistics Office, Ministry of Health, Tropical Diseases Research Centre, University of Zambia
and Macro International Inc. (2009) Zambia Demographic and Health Survey, 2007. CSO and Macro
International Inc., Calverton.
[2] Central Statistics Office (2012) Zambia 2010 Census of Population and Housing. Population Summary
[3] National HIV/AIDS/STI/TB Council (Zambia) (2004) The HIV/AIDS Epidemic in Zambia.
[4] National HIV/AIDs/STI/TB Council (Zambia) (2009) National Strategy for the Prevention of HIV and STIs.
[5] Ministry of Health (Zambia), Central Statistical Office (Zambia) and ORC Macro (2006) Zambia HIV/AIDS
Service Provision Assessment Survey 2005. Ministry of Health, Central Statistical Office, and ORC Macro,Calverton.
[6] National HIV/AIDS/STI/TB Council (Zambia) (2009) National Strategy for the Prevention of HIV and STIs.
[7] National HIV/AIDS/STI/TB Council (Zambia) (2010) National AIDS Strategic Framework 2011-2015.
[8] National HIV/AIDS/STI/TB Council (Zambia) (2011) Report of the 2011 National HIV Prevention Convention 15th-17th November 2011.
[9] Donnell, D., Baeten, J.M., Kiarie, J., Thomas, K.K., Stevens, W., Cohen, C.R., McIntyre, J., Lingappa,
J.R. and Celum, C. (2010) Heterosexual HIV-1 Transmission after Initiation of Antiretroviral Therapy:
A Prospective Cohort Analysis. Lancet, 375, 2092-2098.
[10] Cohen, M.S., Chen, Y.Q., McCauley, M., et al. (2011) Prevention of HIV-1 Infection with Early
Antiretroviral Therapy. New England Journal of Medicine, 365, 493-505.
[11] Ministry of Health (Zambia) (2010) Adult and Adolescent Antiretroviral Therapy Protocols 2010.
[12] Hanefeld, J. and Musheke, M. (2009) What Impact Do Global Health Initiatives Have on Human
Resources for Antiretroviral Treatment Roll-Out? A Qualitative Policy Analysis of Implementation
Processes in Zambia. Human Resources for Health, 7, 8.
[13] United Nations (2004) The Impact on the Health Sector in Impact of AIDS. Department of Economic
and Social Affairs Population Division.
[14] Tawfik, L. and Kinoti, S.N. (2006) The Impact of HIV/AIDS on the Health Workforce in Developing
Countries. Background Paper Prepared for The World Health Report 2006, Working Together for Health.
[15] World Health Organization (2004) Standards for quality HIV Care: A Tool for Quality Assessment,
Improvement, and Accreditation. Report of a WHO Consultation Meeting on the Accreditation of Health Service Facilities for HIV Care. Geneva.
[16] Rosen, S., Vincent, J.R., MacLeod, W., Fox, M., Thea, D.M. and Simon, J.L. (2004) The Cost of
HIV/AIDS to Businesses in Southern Africa. AIDS, 18, 317-324.
[17] Ramiah, I. and Reich, M.R. (2006) Building Effective Public-Private Partnerships: Experiences and
Lessons from the African Comprehensive HIV/AIDS Partnerships (ACHAP). Social Science & Medicine, 63, 397-408.
[18] The Commission on HIV/AIDS and Governance in Africa (2006) HIV/AIDS and the Private Sector in
Africa: Impact and Responses. United Nations Economic Commission for Africa.
[19] Center for Global Development (2009) Partnerships with the Private Sector in Health. What the
International Community Can Do to Strengthen Health Systems in Developing
Countries. Final Report of the Private Sector Advisory Facility Working Group.
[20] Joint United Nations Programme on HIV/AIDS (2009) HIV-Related Public-Private Partnerships and
Health Systems Strengthening.
[21] Ramiah, I. and Reich, M.R. (2005) Public-Private Partnerships and Antiretroviral Drugs for HIV/AIDS:
Lessons from Botswana. Health Affairs, 24, 545-551.
[22] Sturchio, J.L. and Cohen, G.M. (2012) PEPFAR’s Public-Private Partnerships Achieved Ambitious
Goals, from Improving Labs to Strengthening Supply Chains. Health Affairs, 31, 1450-1458.
[23] Sulzbach, S., De, S. and Wang, W. (2011) The Private Sector Role in HIV/AIDS in the Context of an
Expanded Global Response: Expenditure Trends in Five Sub-Saharan African Countries.
Health Policy and Planning, 26, i72-i84.
[24] Williams, H.A. and Jones, C.O. (2004) A Critical Review of Behavioral Issues Related to Malaria Control in Sub-Saharan Africa: What Contributions Have Social Scientists Made? Social Science and Medicine, 59, 501-523.
[25] Siegfried, N., Uthman, O.A. and Rutherford, G.W. (2010) Optimal Time for Initiation of Antiretroviral
Therapy in Asymptomatic, HIV-Infected, Treatment-Naive Adults (Review).
Cochrane Database of Systematic Reviews Issue 3, Article No. CD008272.
[26] World Health Organization (2003) Adherence to Long-Term Therapies Evidence for Action.
[27] Hardon, A., Davey, S., Gerrits, T., Hodgkin, C., Irunde, H., Kgatlwane, J., Kinsman, J., Nakiyemba, A.
and Laing, R. (2006) From Access to Adherence: The Challenges of Antiretroviral Treatment—
Studies from Botswana, Tanzania and Uganda.
[28] World Health Organization (2012) Antiretroviral Treatment as Prevention (TASP) of HIV and
TB. Programmatic Update.
[29] World Health Organization/Joint United Nations Programme on HIV/AIDS (2011) The Treatment 2.0
Framework for Action: Catalysing. The Next Phase of Treatment, Are and Support.
[30] World Health Organization (2013) Global Update on HIV Treatment 2013. Results, Impacts and
[31] Van Damme, W., Kober, K. and Kegal, G. (2008) Scaling-Up Antiretroviral Treatment in Southern
African Countries with Human Resource Shortage. How Will Health System Adapt.
Social Science and Medicine, 66, 2108-2121.
[32] Assefa, Y., Jerene, D., Lulseged, S., Ooms, G. and Van Damme, W. (2009) Rapid Scale-Up of
Antiretroviral Treatment in Ethiopia: Successes and System-Wide Effects. PLoS Medicine, 6, e1000056.
[33] Fomundam, H., Tesfay, A., Maranga, A., Chanetsa, L., Muzoola, V. and Oyaro, F. (2012) Identifying
Treatment and Healthcare Seeking Behavior as a Means of Early HIV/AIDS Intervention in Africa.
World Journal of AIDS, 2, 165-173.
[34] World Health Organization (2006) The World Health Report 2006: Working Together for Health.
[35] Mæstad, O. (2006) Human Resources for Health in Tanzania: Challenges, Policy Options and
Knowledge Gaps. CMI Report.
[36] Bärnighausen, T., Bloom, D.E. and Humair, S. (2007) Human Resources for Treating HIV/AIDS: Needs,
Capacities, and Gaps. AIDS Patient Care and STDS, 21, 799-812.
[37] World Health Organization (2012) Programmatic Update. Antiretroviral Treatment as
Prevention (TASP) of HIV and TB.
[38] McMahon, J.H., Jordan, M.R., Kelley, K., Bertagnolio, S., Hong, S.Y., Wanke, C.A., Lewin, S.R. and
Elliott, J.H. (2011) Pharmacy Adherence Measures to Assess Adherence to Antiretroviral Therapy:
Review of the Literature and Implications for Treatment Monitoring. Clinical Infectious Diseases, 52, 493-506.
[39] Mermin, J., Ekwaru, J.P., Were, W., Degerman, R., Bunnell, R., Kaharuza, F., Downing, R., Coutinho, A., Solberg, P., Alexander, L.N., Tappero, J., Campbell, J. and Moore,
D.M. (2011) Utility of Routine Viral Load, CD4 Cell Count, and Clinical Monitoring among Adults with
HIV Receiving Antiretroviral Therapy in Uganda:
Randomised Trial. British Medical Journal, 343, d6792.
[40] Hawkins, T. (2010) Understanding and Managing the Adverse Effects of Antiretroviral Therapy.
Antiviral Research, 85, 201-209.
[41] Johnson, M.O., Dilworth, S.E., Taylor, J.M. and Neilands, T.B. (2011) Improving Coping Skills for
Self-Management of Treatment Side Effects Can Reduce Antiretroviral Medication
Non-Adherence among People Living with HIV. Annals of Behavioral Medicine, 41, 83-91.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.