Irrational Prescribing and Dispensing of Antiretroviral Medicines in Kamwokya Christian Caring Community Center, Kampala.

Abstract

Background: An effective response to the challenges of HIV/AIDS treatment must include correct prescribing and dispensing of antiretroviral medicines. However, the magnitude and factors influencing irrational prescribing and dispensing of antiretroviral medicines in Kamwokya Health Center (KCCC) have not been assessed. Objectives: The main objective of this study was to determine the magnitude of and factors contributing to irrational prescribing and dispensing practices among health workers prescribing and dispensing ARVs in Kamwokya Christian Community Health Centre. Methodology: In a descriptive cross sectional design, 384 patient files were retrieved and 2 prescriptions randomly sampled per year for period of 2 years (total 1,536) to collect quantitative data on the prescribed ARVs in August 2013, and were scored using patient chart review tool. Qualitative data was collected using structured questionnaire (n=20) and key informant interview guides (n=8). Results: A total of 1,536 prescriptions were extracted and analysed. Some 69 prescriptions were dropped due to incomplete data thus 1,467 were finally analysed. Of these, 1,422 (96.6%) prescriptions were for adult >15yrs and 45 (3.1%) were children > 15 years Overall irrational prescribing and dispensing was 8.1%. In 44/1467 (3%) of the prescriptions, the ARV regimen prescribed were different from the ARV regimen dispensed. This difference was more common in the regimens for children compared to adult regimens OR=14.71; 95%CI: 6.99 - 30.92; p<0.001, only 29/1,462.0%). There were variations in quantities of ARVs prescribed versus quantities of ARVs dispensed (OR=2.64; 95% CI: 1.26 - 5.51; p=0.010). Comparing quantities of ARVs dispensed versus next appointment date, 1427 (97.3%) of prescriptions were adequately fulfilled to cover the duration of the appointment. Pediatric prescriptions were more likely to vary compared to adult prescriptions. Conclusion: Irrational prescribing and dispensing of ARVs in Kamwokya Christian Caring Community was low across the various categories considered but more common among pediatric clients. This was more common in the pediatric regimens compared to adults’ regimens. Health workers attributed the observed irrational ARV drug use to heavy workload and low staffing levels. Recommendation: Training of health workers should focus on pediatric ART prescribing and dispensing.