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Adopción de nuevas guías de tratamiento del VIH y sustitución de los medicamentos de primera línea como una medida de calidad en áreas rurales de Lesoto: comparación entre centros sanitarios y hospitales
Author(s) -
Labhardt Niklaus D.,
Sello Motlalepula,
Lejone Thabo,
Ehmer Jochen,
Mokhantso Mohlaba,
Lynen Lutgarde,
Pfeiffer Karolin
Publication year - 2012
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2012.03051.x
Subject(s) - medicine , stavudine , medical prescription , lamivudine , logistic regression , zidovudine , odds ratio , health care , family medicine , human immunodeficiency virus (hiv) , pediatrics , antiretroviral therapy , viral load , nursing , virology , hepatitis b virus , virus , viral disease , economics , economic growth
Objective In 2007, Lesotho launched new national antiretroviral treatment (ART) guidelines, prioritising tenofovir and zidovudine over stavudine as a backbone together with lamivudine. We compared the rate of adoption of these new guidelines and substitution of first‐line drugs by health centers (HC) and hospitals in two catchment areas in rural Lesotho. Methods Retrospective cohort analysis. Patients aged ≥16 years were stratified into a HC‐ and a hospital‐group. Main outcome variables: Type of backbone at ART‐initiation (i), substitutions within first line (ii) and type of backbone among patients retained by December 2010 (iii). A multiple logistic regression model including HC vs. hospital, patient characteristics (sex, age, WHO‐stage, baseline CD4‐count, concurrent pregnancy, concurrent tuberculosis treatment) and year of ART‐start, was used. Results Of 3936 adult patients initiated on ART between 2007 and 2010, 1971 started at hospitals and 1965 at HCs. Hospitals were more likely to follow the new guidelines as measured by prescription of backbones without stavudine (Odds‐ratio 1.55; 95%CI: 1.32–1.81) and had a higher rate of drug substitutions while on first‐line ART (2.39; 1.83–3.13). By December 2010, patients followed at health centres were more likely to still receive stavudine (2.28; 1.83–2.84). Conclusions Health centers took longer to adopt the new guidelines and substituted drugs less frequently. Decentralised ART‐programmes need close support, supervision and mentoring to absorb new guidelines and to adhere to them.