Tegegne Bantayehu Addis, Alehegn Agumas Alemu, Kassahun Mengistie
Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
Department of Pharmacy, Lumame Primary Hospital, Lumame, Ethiopia; Health Supplies and Laboratory Equipments Management Directorate Director, Amhara National Regional State Public Health Institute, Bahirdar, Ethiopia.
Integr Pharm Res Pract. 2024 Apr 18;13:31-42. doi: 10.2147/IPRP.S455351. eCollection 2024.
A key strategy for quality improvement is drug use evaluation, which looks at the safe, appropriate use of medication principles. Tenofovir/Lamivudine/Dolutegravir (TLD-FDC) usage has not yet been sufficiently examined in published literature. The purpose of this study was to assess how TLD were used by HIV-positive patients Using WHO drug use evaluation standards in Lumame Primary Hospital, North West Ethiopia.
Using WHO drug use evaluation standards, a retrospective study design was used to evaluate the appropriateness of TLD use. Systematic random sampling was utilized to gather patient medical records containing TLD. Accordingly, 100 records that met the inclusion criteria were selected and reviewed between April 1 and 15, 2021. Five criteria, namely, indication, dose, contraindication, drug interaction, and TLD safety monitoring were used to evaluate the appropriateness of TLD utilization.
80% of patients were transited to TLD from other regimens. The median time on TLD was found to be 13 months with 9 months to 18 months IQR. The latest CD4 count as well as CD4 count at the initiation or transition of TLD was not done for 75% and 89% of the patients, respectively. 3/4 (75%) of the patients were found to have a scheduled medication refill history. TLD dosing, indications, and contraindications were found to be 100% appropriate. No, TLD safety monitoring tests were done for 21% of the patients in this study. However, viral load, liver/kidney function, and serum creatinine tests were done for 77% (95% CI: 74%-79%), 5% (95% CI: 2%-8%), and 14% (95% CI: 11%-17%) of the patients, respectively. More over, In 93% (95% CI: 91%-95%) of the patients, the TLD interaction was appropriate; in 7%, it was not. All recording, documenting, and reporting technologies were available and used efficiently, except for the Electronic Dispensing Tool.
Generally, good adherence to national and WHO guidelines was obtained regarding dose, indication, and contraindications. However, improvement in safety monitoring tests and CPT utilization is recommended. Drug interactions satisfied the majority of the criteria's threshold, while certain standards were not followed.
质量改进的一项关键策略是药物使用评估，其关注药物使用原则的安全、恰当性。替诺福韦/拉米夫定/多替拉韦（TLD复方制剂）的使用在已发表文献中尚未得到充分研究。本研究的目的是在埃塞俄比亚西北部卢马梅初级医院，使用世界卫生组织药物使用评估标准，评估HIV阳性患者对TLD的使用情况。
采用世界卫生组织药物使用评估标准，运用回顾性研究设计来评估TLD使用的恰当性。利用系统随机抽样收集包含TLD的患者病历。据此，在2021年4月1日至15日期间，选取并审查了100份符合纳入标准的病历。使用五项标准，即适应证、剂量、禁忌证、药物相互作用和TLD安全性监测，来评估TLD使用的恰当性。
80%的患者从其他治疗方案转换为使用TLD。发现使用TLD的中位时间为13个月，四分位间距为9个月至18个月。分别有75%和89%的患者未进行TLD起始或转换时的最新CD4计数以及CD4计数。四分之三（75%）的患者有定期药物 refill记录。发现TLD的给药、适应证和禁忌证100%恰当。在本研究中，21%的患者未进行TLD安全性监测检查。然而，分别有77%（95%置信区间：74%-79%）、5%（95%置信区间：2%-8%）和14%（95%置信区间：11%-17%）的患者进行了病毒载量、肝/肾功能和血清肌酐检查。此外，93%（95%置信区间：91%-95%）的患者TLD相互作用恰当；7%的患者不恰当。除电子配药工具外，所有记录、文档记录和报告技术均可用且使用效率高。
总体而言，在剂量、适应证和禁忌证方面，对国家和世界卫生组织指南的遵循情况良好。然而，建议改进安全性监测检查和CPT的使用。药物相互作用满足了大多数标准阈值，但某些标准未得到遵循。
