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The development of a care‐focused, adherence‐tracking dispensing database for HIV care in a resource‐constrained setting

Sub-Saharan Africa is experiencing an AIDS epidemic on a massive scale. In 2008 there were 22.4 million patients living with HIV/AIDS in this region, and this population is growing steadily. The people of Kenya have not been spared from the effects of this devastating disease. In fact, 6.7% of the Kenyan population requires HIV medical management. Although this percentage is high, the mortality due to AIDS has decreased significantly since 2006, when the President of Kenya announced that antiretroviral drugs would be provided free in public hospitals and health centres. Three years after this policy was introduced, the number of people receiving antiretroviral therapy reached 336 980, representing 70.4% of the HIV-positive population. The primary focus of HIV management in Kenya is now on maximizing HIV patients’ adherence to antiretroviral drug therapy in order to increase quality of life and life expectancy. Proper medication adherence is necessary for successful HIV management, but there are many barriers to antiretroviral medication adherence in resource-constrained settings. A study done in a city in Kenya identified the key factors affecting adherence as being ‘away from home’, ‘busy’ or simply ‘forgetting’. All of these factors are highly modifiable if a more patient-focused healthcare infrastructure can be developed. No standard method of measuring medication adherence exists in this region of the world. Self-reporting is the most commonly used method to track adherence, but it does not accurately monitor how patients are actually taking medications. One study suggested that only 43.2% of patients at a Kenyan tertiary health institution effectively adhered to their scheduled drug regimen. Additional data from a pilot pill-count study, which measured adherence among Kenyan HIV/AIDS patients in a pharmacy clinic, suggested that a significant discrepancy existed between pill-count data and self-reported adherence to HIV regimens, further highlighting the inadequacy of self-reporting. A more accurate means of tracking adherence is desired in these resource-constrained settings. Several studies suggest that there is a need to redefine how adherence should be measured. The World Health Organization (WHO) suggests the use of multiple monitoring parameters for HIV regimen adherence, including viral load status, CD4+ counts, pharmacy refill history, pill counts and adequate disease-management education. Among these many methods of measuring adherence, only pharmacy refill history and patient education have the potential to proactively predict treatment failure before it occurs. Additionally, the reliability and economy of the pill-count method has been demonstrated in a study undertaken by the Drug Resources Enhancement Against AIDS and Malnutrition (DREAM) programme in Mozambique. A vital part of these pharmacy-based interventions entails the implementation of technologies that can integrate information, allow for easier data access and provide platforms for rapid interpretation of pharmacy intervention data. The WHO recognizes the importance of such platforms, and recommends implementation in all settings capable of supporting them. Correspondence: Ellen Schellhase, Pharmacy Practice, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN 47907-2091, USA. E-mail: elschell@iupui.edu bs_bs_banner