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Drug utilization study of HIV positive patients registered with antiretroviral therapy centre of a tertiary care hospital

Objective: To determine the drug utilization pattern among HIV (Human Immunodeficiency Virus) outpatients in antiretroviral therapy (ART) centre of a tertiary care hospital. 
 
Method: We conducted a prospective, longitudinal follow up study of one year duration. Collected data was analyzed using descriptive statistics. 
 
Results: A total of 1491 prescriptions were collected from 250 HIV positive patients. Majority of the drugs were prescribed in oral dosage form. The average number of drugs per encounter was 4.26 and the average drug cost per encounter was INR 850.52. In majority of encounters (52.9%) first line HAART regimen was prescribed. The most common regimen prescribed among the first line HAART was the combination of Zidovudine, Lamivudine and Nevirapine (26.76%). The medication class most commonly prescribed were antiretroviral agents (39%). Antimicrobial agents were the second most common class of drugs prescribed (29.6%) with cotrimoxazole being the most common. The third most commonly prescribed drug class was vitamins (18.72%). There were total of 36 substitutions within the first line regimens with substitution of zidovudine by stavudine being the most common. In our study the optimal level of adherence as suggested by the national guidelines was achieved in 87.77% of encounters. 
 
Conclusion: Overall our results suggest that the prescribing pattern to be in accordance with national guidelines but there still remains a scope for improvement by using viral load as a biomarker instead of CD4 count. Also we would suggest a periodical external quality assessment of counsellors of all ART centres for further enhancement of adherence level.