Effects of antiretroviral medicines dispensing and management practices on client-based outcome indicators among adolescent HIV positive/AIDS patients in Kumasi Metropolis

Introduction: One of the goals of UNAIDS’ 90-90-90 is ensuring that 90 percent of people on antiretroviral (ARV) treatment are virally suppressed. Inadequate ARV medication dispensing and management by healthcare providers can contribute to poor outcomes. The aim of this study was to assess the effects of antiretroviral medicines dispensing and management practices on client-based outcome indicators among adolescent HIV positive patients in Kumasi Metropolis in the Ashanti Region, Ghana.

Method: Both quantitative and qualitative studies were conducted at four selected ART clinics, from September 2017 to February 2018. In-depth individual interviews were conducted with consented 120 patients (aged 10-19 years) on ARVs for a minimum period of one year to assess their understanding of dispensing instructions. Record extraction sheets were used to retrospectively and independently collect data on medicine stock-out periods, adherence appointment-keeping and clinical wellness from records. Healthcare professionals involved in medicine management at the participating ART facilities were identified by observation and interviewed using a standard questionnaire. The data were coded, stored and analysed using SPSS 16.0. Thematic approach was used to analyse the qualitative data.    

Results and Discussion: Key ARVs availability at the four ART facilities were 62 %, 75 %, 92 %, and 99 %. 60 % of the clients received all the medications. All the medicines were correctly, completely and legibly labelled more often; clients better understood when, how much and for how long they were supposed to take their prescribed medicines. Only 2 of the 4 ART sites showed correct recording of stock information about ARVs. All the 4 ART sites had pharmacists managing the ARVs. 65% demonstrated good adherence to the ARVs.  57 % of the clients who received all their medications demonstrated good adherence; good clinical wellness (maintaining stable/increase body weight, decrease in frequency/severity of opportunistic infections and exhibiting good functional status); and improved in viral loads.

Conclusions: There were stock-outs of some of the ARVs. Patients who received all their medications had adequate dispensing and exhibited good adherence.