Nakiwogga-Muwanga A, Katabira E, Kiragga A, Kambugu A, Nakibuuka-Lubwama E, Manabe Y C, Alamo S T, Colebunders R
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
Int J STD AIDS. 2014 Feb;25(2):105-12. doi: 10.1177/0956462413492715. Epub 2013 Jul 19.
A Pharmacy-only Refill Programme (PRP) a type of task shifting in which stable HIV-positive patients are managed through pharmacy-only visits instead of physician visits. We performed a study to identify factors for being removed from the PRP in order to establish better referral criteria. The study was performed at the Infectious Disease Clinic (IDC) in Kampala, Uganda. We selected a random sample of 588 patients from 2431 patients on antiretroviral therapy referred to the PRP at least 12 months before commencement of the PRP evaluation. We compared the characteristics of patients who during 12 months of follow-up were removed from the PRP with those who continued to be followed up. Data were abstracted from the IDC data base, the pharmacy register and the patient clinical notes. Of 588 patients, 106 (18%) were removed from the PRP. In multivariate analysis, less than 100% self-reported adherence to antiretroviral therapy, missing at least one scheduled appointment in the six months before referral to the PRP and being on a lopinavir/ritonavir-containing regimen were independently associated with being removed from the PRP. Criteria for referring patients to a PRP should focus on antiretroviral therapy adherence and appointment keeping. Patients on a lopinavir/ritonavir-containing regimen should not be targeted for a PRP. On the other hand a PRP is an efficient strategy that targets stable adherent patients in clinics with high patient load.
仅通过药房进行的再填充计划（PRP）是一种任务转移方式，即通过仅到药房就诊而非医生就诊来管理病情稳定的HIV阳性患者。我们开展了一项研究，以确定从PRP中被剔除的因素，从而制定更好的转诊标准。该研究在乌干达坎帕拉的传染病诊所（IDC）进行。我们从2431名接受抗逆转录病毒治疗的患者中随机抽取了588名患者，这些患者在PRP评估开始前至少12个月就被转诊至PRP。我们比较了在12个月随访期间从PRP中被剔除的患者与继续接受随访的患者的特征。数据从IDC数据库、药房登记册和患者临床记录中提取。在588名患者中，106名（18%）被从PRP中剔除。在多变量分析中，自我报告的抗逆转录病毒治疗依从性低于100%、在转诊至PRP前六个月内至少错过一次预定预约以及采用含洛匹那韦/利托那韦的治疗方案与从PRP中被剔除独立相关。将患者转诊至PRP的标准应侧重于抗逆转录病毒治疗的依从性和按时就诊。采用含洛匹那韦/利托那韦治疗方案的患者不应成为PRP的目标对象。另一方面，PRP是一种有效的策略，适用于患者量大的诊所中病情稳定且依从性好的患者。
