Abstract:
Background: Effective ART with low viral loads and absence of STIs significantly reduce chances of
sexual transmission of HIV. ART is therefore a key pillar in HIV prevention. Appropriate support is
however essential for optimum treatment outcome, patient safety and HIV prevention benefit. The
scale-up of ART continues to strain the already overstretched human resources in public facilities,
impacts on the quality of care, and contributes to loss to follow-up. Task shifting is therefore a
strategy to augment the limited human resources. Methodology: In partnership with the Livingstone
General Hospital (LGH) and four private pharmacists, the COH III Project through Howard
University is promoting quality HIV care by engaging the pharmacists in adherence counselling
and treatment monitoring. The LGH ART pharmacist allocates consenting stable ART clients to
pharmacies based on willingness to be referred and patient preference. Patients are given schedule
of visits to pharmacies where the pharmacists provide medication/adherence counselling and
monitor side effects. Patients with medication/treatment issues are referred back to the LGH ART
clinic for follow-up. Results: Between October 2012 and August 2013, 280 patients were enrolled
and followed up by the four pharmacists. 69% of patients visited the pharmacy at least once, 25%
at least twice and 13% at least thrice. The 33 client referrals by pharmacists to LGH were related
to adverse drug reactions, suspected treatment failure, pregnancy, and treatment monitoring. The intervention has reduced workload for the ART pharmacist; improved communication of treatment
challenges and identification of patients with medication related problems, and reduced
travel distances and waiting times. This has resulted in improved adherence and better patient
outcomes. Conclusion: Private pharmacists present an opportunity to improve quality of HIV interventions
in poor human resource capacity settings. The necessary legal and regulatory framework
needs to however be developed to guide the process
