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Antiretrovial (ARV) drug utilisation in Harare
N Z Nyazema1, S Khoza, I Landman
1Department of Clinical Pharmacology, University of Zimbabwe Medical School, P O Box A178, Avondale, Harare, Zimbabwe.
Objective:
To investigate ARV utilisation in Harare in order to gather necessary data to help in the formulation of treatment guidelines to be used in Zimbabwe.
Design:
A cross sectional study.
Setting:
Doctors' rooms and retail pharmacy outlets.
Subjects:
68 primary care physicians, 80 pharmacists and 92 patients.
Main Outcome Measures:
Number of physicians prescribing antiretroviral agents (ARVs) and pharmacists stocking ARVs. Type of ARV utilised, cost to the patient and information on ARV available.
Results:
Out of the 68 private practitioners interviewed 18 were prescribing ARVs during the period of study. There were 92 patients on ARVs whose mean age was 35 +/- 5 years and consuming an average total of 17 tablets daily. Thirteen out of the 18 doctors had access to laboratory facilities to determine CD4 counts and viral load. The rest were using other approaches to treat and manage HIV/AIDS patients. About a quarter, 27.0%, of the retail pharmacists stocked ARVs. The majority, 82.0%, of the patients appeared to be on Zidovudine (AZT) mainly in combination with other drugs. The most popular combination was that of AZT, Lamivudine (3TC) and Indinavir prescribed to 29.0% of the patients, followed by that of Didanosine (DDI) and hydroxyurea prescribed to 17% of patients. At least 17% of the patients were on AZT monotherapy. There was no significant difference (p = 0.06) in the number of tablets consumed by patients who had other conditions secondary to HIV infection. Only 39 out of the 92 patients reported untoward experiences with ARVs. The major problem being associated gastro-intestinal disturbance which accounted for 56% of the reports. It was not possible to ascertain adherence.
Conclusion:
There appeared to be therapeutic anarchy in the private sector in Harare in the way ARVs were being used. Patients need to be told that deciding to take one of the combinations means making a serious commitment to the drugs on schedule if they want to enjoy the benefit. At the same time there is need to develop and publicize HIV/AIDS treatment guidelines and effective Information, Education and Communication (IEC) materials specific to Zimbabwe.