TITLE:
Improving HIV Treatment Adherence through a Public Private Partnership in Zambia
AUTHORS:
Henry Fomundam, Andrew Maranga, Joseph Kamanga, Abraham Tesfay, Tamara Choola, Stephen Nyangu, Anthony Wutoh
KEYWORDS:
Public-Private Partnership; Adherence Support; Private Pharmacists; Treatment Monitoring; Human Resources Challenge
JOURNAL NAME:
World Journal of AIDS,
Vol.4 No.1,
March
26,
2014
ABSTRACT:
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.