Tenofovir related renal toxicity monitoring in antiretroviral therapy (ART) accredited sites: A situational analysis for Uganda

Abstract

Background: In Uganda, Tenofovir-based regimen is recommended as first line particularly for HIV/AIDS adult and adolescent patient and for option B+ in prevention of mother-to-child transmission (PMTCT). As a result of Tenofovir (TDF) associated renal toxicity, it is recommended that all HIV/AIDS patients receiving TDF based regimen are routinely monitored for renal dysfunction. Whether routine renal function monitoring is done and which factors are associated with the practice in Uganda is to-date poorly documented. This study was conducted to assess compliance of monitoring of Tenofovir Disoproxil Fumerate (TDF) related renal toxicity among adults receiving TDF based-regimens in antiretroviral therapy (ART) accredited sites in Uganda. Methods: A cross section study was conducted in 95 ART accredited sites. A structured questionnaire and key informant interviews were used to collect data. Both univariate and multivariate models were fitted in addition to descriptive analysis of quantitative data while qualitative data were analysed on basis of thematic areas of the study. Findings: None of the 95 facilities in the study complied to monitoring patients on TDF based regimen as required by the guidelines. However, 24 % of facilities were monitoring at a level of 50% and 55%monitoring at 25% level.Only two facilities were monitoring at 75%.Renal function tests (Serum biochemistry tests)were done by 6% of the facilities to monitor patients at baseline and after six months. .Proteinuria, glucosuria, serum creatinine, blood urea and uric acid were considered most critical for detecting possible renal toxicity. The odds of monitoring is higher in facilities with guidelines (OR: 8.97; 95%CI: 1.22-80.53) compared to facilities without guidelines. The prescriber cadre level influenced monitoring (OR: 2.59; 95%CI 0.48-13.9) but the effect was not statistically significant. Qualitative data revealed that inadequate laboratory infrastructure was among the factors contributing to poor monitoring patients in facilities. Conclusion and Recommendation: Compliance to Monitoring requirements for patients on TDF based regimen is very poor in Uganda and it is hindered by a multitude of factors including unclear guidelines, inadequate training and inadequate laboratory infrastructure. Provision of guidelines for screening and monitoring at-risk patients, improving laboratory services, and support supervision of health workers may improve TDF associated renal toxicity monitoring in ART-accredited health care facilities in Uganda.