ABSTRACT
Background: A Rational Medication Use Review (RMUR) was conducted at four facilities providing antiretroviral therapy in Burundi as a simple and practical strategy for service providers and programme managers to continuously assess and monitor quality of ART services provided. Methods: A comprehensive data collection tool was developed to systematically and retrospectively capture relevant data from randomly selected ART patient files in the four ART facilities. Results: ART data from 157 patients receiving ART services from four facilities was extracted and analysed. WHO stage 4 AIDS defining diseases were recorded in 125 (79.6%) of the patients at the time of ART initiation. The most frequent opportunistic infections and/or co-morbidities were cryptosporidiosis (14.4%), HIV wasting (14.4%), tuberculosis (13%) and candidiasis (17.4%). 97.8% of the patients were taking concomitant medicines. A large percentage of patients (72.4%) had done a baseline CD4 test before initiation of therapy with a majority of the patients (85.8%) getting their lab results within one week of the collection of the specimens. For some patients (9%), it took up to 8 weeks to get test results. About 21.8% of the patients were hospitalized at least once while on ART and 11.2% of the hospitalized patients died. Conclusion: " RMUR is a simple and practical strategy that can be appropriately modified to suite local settings. It offers a cost-effective and participatory method of identifying and correcting factors that may negatively impact the quality of care and desired outcomes for patients on ART.
ABSTRACT
Abstract: The aim of this prospective study (20 months) was to assess HIV patients' use of Traditional, Complementary and Alternative Medicine (TCAM) and its effect on ARV adherence at three public hospitals in KwaZulu-Natal, South Africa. Seven hundred and thirty-five (29.8% male and 70.2% female) patients who consecutively attended three HIV clinics completed assessments prior to ARV initiation, 519 after 6 months, 557 after 12 and 499 after 20 months on antiretroviral therapy (ART). Results indicate that following initiation of ARV therapy the use of herbal therapies for HIV declined significantly from 36.6% prior to ARV therapy to 8.0% after 6 months, 4.1% after 12 months and 0.6% after 20 months on ARVs. Faith healing methods (including spiritual practices and prayer) declined from 35.8% to 22.1%, 20.8% and 15.5%, respectively. In contrast, the use of micronutrients (vitamins, etc.) significantly increased from 42.6% to 78.2%. The major herbal remedies that were used prior to ART were unnamed traditional medicine, followed by imbiza (Scilla natalensis planch), canova (immune booster), izifozonke (essential vitamins mixed with herbs), African potato (Hypoxis hemerocallidea), stametta (aloe mixed with vitamins and herbs) and ingwe (tonic). Herbal remedies were mainly used for pain relief, as immune booster and for stopping diarrhea. As herbal treatment for HIV was associated with reduced ARV adherence, patient's use of TCAM should be considered in ARV adherence management