Mungati More, Mhangara Mutsa, Dzangare Janet, Mugurungi Owen, Apollo Tsitsi, Gonese Elizabeth, Kilmarx Peter H, Chakanyuka-Musanhu Christine C, Shambira Gerald, Tshimanga Mufuta
AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe.
Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
J Epidemiol Res. 2016;2(2):85-91. doi: 10.5430/jer.v2n2p85.
This study evaluated the performance of sentinel sites in preventing the emergence of HIVDR using Early Warning Indicators (HIVDR EWI) survey.
Adult and paediatric patient data on: On time pill pick up, Retention in care, Pharmacy stock-outs, and Dispensing practices was collected. Information from pharmacy registers was verified using facility-held cards. This was a cross-sectional analysis of retrospectively collected data from 72 sites providing both adult and paediatric ART as well as two providing adult ART only. All data were entered into and analysed using a WHO EWI data abstraction electronic tool.
Twenty-one percent of sites providing adult and 4.2% of sites providing paediatric ART managed to meet the target for on time pill pick up. Retention in care indicator was met by 48.7% (95% CI: 36.9-60.6) of sites. ARV stock-outs occurred in 81.1% (95% CI: 70-89.3) adult sites and 63.9% (95% CI: 50-78.6) paediatric sites. ARVs were appropriately dispensed by 86.5% (95% CI: 75.6-93.3) of adult sites and 84.7% (95% CI: 74.3-92.1) of paediatric sites.
Most sites had low performance in many indicators in this survey and failed to meet the recommended targets. Some policies such as the current buffer stock and storage outside Harare should be revised in order to improve site access to ARVs. The country should prioritize the provision of viral load testing services in all provinces. The electronic patient management system should be rolled out to all ART sites to improve patient tracking and monitoring by sites.
本研究使用早期预警指标（HIVDR EWI）调查评估了哨点在预防HIV耐药性出现方面的表现。
收集了成人和儿科患者在按时取药、持续接受治疗、药房药品缺货以及配药操作方面的数据。药房登记信息通过机构持有的卡片进行核实。这是一项对从72个提供成人和儿科抗逆转录病毒治疗的地点以及两个仅提供成人抗逆转录病毒治疗的地点回顾性收集的数据进行的横断面分析。所有数据均使用世卫组织EWI数据提取电子工具录入并分析。
提供成人抗逆转录病毒治疗的地点中有21%、提供儿科抗逆转录病毒治疗的地点中有4.2%成功达到了按时取药的目标。48.7%（95%置信区间：36.9 - 60.6）的地点达到了持续接受治疗指标。81.1%（95%置信区间：70 - 89.3）的成人治疗地点和63.9%（95%置信区间：50 - 78.6）的儿科治疗地点出现了抗逆转录病毒药物缺货情况。86.5%（95%置信区间：75.6 - 93.3）的成人治疗地点和84.7%（95%置信区间：74.3 - 92.1）的儿科治疗地点正确配药。
在本次调查中，大多数地点在许多指标上表现不佳，未达到推荐目标。应修订一些政策，如当前的缓冲库存和哈拉雷以外的储存政策，以改善各地点获取抗逆转录病毒药物的情况。该国应优先在所有省份提供病毒载量检测服务。应将电子患者管理系统推广到所有抗逆转录病毒治疗地点，以改善各地点对患者的跟踪和监测。
