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dc.contributor.authorArmitage, Gerry R.*
dc.contributor.authorHodgson, Ian J.*
dc.contributor.authorWright, J.*
dc.contributor.authorBailey, K.*
dc.contributor.authorMkhwana, E.*
dc.date.accessioned2014-12-18T15:14:30Z
dc.date.available2014-12-18T15:14:30Z
dc.date.issued2011
dc.identifier.citationArmitage, 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.
dc.identifier.urihttp://hdl.handle.net/10454/6787
dc.description.abstractTo 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.
dc.language.isoenen
dc.subjectAdult
dc.subjectAmbulatory Care Facilities
dc.subjectAnti-Retroviral Agents
dc.subjectHIV Infections
dc.subjectHealth Knowledge
dc.subjectAttitudes
dc.subjectPractice
dc.subjectHospitals
dc.subjectRural
dc.subjectHumans
dc.subjectInterviews as Topic
dc.subjectMale
dc.subjectRegional Medical Programs
dc.subjectRisk Management
dc.subjectSafety Management
dc.subjectSwaziland
dc.subjectSystems Analysis
dc.subjectTreatment Failure
dc.titleExploring the delivery of antiretroviral therapy for symptomatic HIV in Swaziland: threats to the successful treatment and safety of outpatients attending regional and district clinics
dc.typeArticle
dc.identifier.doihttps://doi.org/10.1136/bmjqs.2009.034512


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