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    Exploring the delivery of antiretroviral therapy for symptomatic HIV in Swaziland: threats to the successful treatment and safety of outpatients attending regional and district clinics

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    Publication date
    2011
    Author
    Armitage, Gerry R.
    Hodgson, Ian J.
    Wright, J.
    Bailey, K.
    Mkhwana, E.
    Keyword
    Adult
    Ambulatory Care Facilities
    Anti-Retroviral Agents/*administration & dosage
    HIV Infections/*drug therapy/psychology
    *Health Knowledge, Attitudes, Practice
    Hospitals, Rural
    Humans
    Interviews as Topic
    Male
    Regional Medical Programs
    *Risk Management
    Safety Management
    Swaziland
    Systems Analysis
    Treatment Failure
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    Abstract
    AIM: To examine the safety and acceptability of providing antiretroviral therapy (ART) in a resource poor setting. DESIGN: Two-stage observational and qualitative study. SETTING: Rural hospital in Southern Africa. METHODS: Structured observation using failure modes and effects analysis (FMEA) of the drug supply, dispensing, prescribing and administration processes. The findings from the FMEA were explored further in qualitative interviews with eight health professionals involved in the delivery of ART. To obtain a patient perspective, a stratified sample of 14 patients receiving ART was also interviewed. RESULTS: Key vulnerabilities in the process of ART provision include supply problems, poor packaging and labelling, inadequate knowledge among staff and lack of staff. Key barriers to successful patient adherence include transport inconsistency in supply and personal financial difficulties. There is, however, strong evidence of patient commitment and adherence. IMPLICATIONS AND CONCLUSION: Medication safety is relatively unexplored in the developing world. This study reveals an encouraging resilience in the health system and adherence among patients in the delivery of complex ART. The vulnerabilities identified, however, undermine patient safety and effectiveness of ART. There are implications for drug manufacturers; international aid agencies funding and supplying ART; and local practitioners. FMEA can help identify potential vulnerabilities and inform safety improvement interventions.
    URI
    http://hdl.handle.net/10454/6787
    Citation
    Armitage, G., Hodgson, I., Wright, J., Bailey, K. and Mkhwana, E. (2011) Exploring the delivery of antiretroviral therapy for symptomatic HIV in Swaziland: threats to the successful treatment and safety of outpatients attending regional and district clinics. BMJ Qual Saf, 20 (1), 52-9.
    Link to publisher’s version
    http://dx.doi.org/10.1136/bmjqs.2009.034512
    Type
    article
    Collections
    Health Studies Publications

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