Assessing adherence to the 2010 antiretroviral guidelines at the antiretroviral rollout clinic in 1 Military Hospital, South Africa: A retrospective, cross sectional study

Alicia Khululwa Khwitshana, Oppel B W Greeff, Tracey Hurrell


Background. HIV research is a therapeutic area for which well-defined population-specific treatment and prophylaxis guidelines exist. However, there are limited objective, evidence-based data for assessing adherence to these guidelines.

Objective. To conduct a retrospective, cross sectional study of adult HIV-infected patients receiving treatment at the antiretroviral (ARV) roll-out clinic of the Infectious Diseases Clinic Pharmacy at 1 Military Hospital (1MH) over a period of 3 years to assess clinicians’ adherence to the 2010 ARV guidelines.

Methods. Pharmacy files from the pool of adult patients receiving treatment at the ARV roll-out clinic between 1 April 2009 and 31 March 2012 were selected. Variables used to establish adherence were assessed through evaluation of pharmacy scripts and laboratory tests.

Results. In accordance with the ARV guidelines, we found a switch in the first-line regimen from stavudine to tenofovir in the period following implementation. There was no difference in baseline blood tests conducted, suggesting that clinicians were recommending a standardised test panel. Notably, similar blood tests were routinely done during follow-up visits, despite no indication for doing so. While the number of blood tests was found to decrease over time, the type of blood tests requested for specific treatment regimens was not in accordance with ARV guidelines.

Conclusion. We used an evidence-based approach to critically assess variations from the delineated ARV guidelines. Adherence to clinical guidelines at 1MH, while demonstrating improvement in patient outcomes, highlighted the need for increased vigilance in monitoring failure of prescribers to comply with ARV guidelines.

Authors' affiliations

Alicia Khululwa Khwitshana, Infectious Disease Clinic,1 Military Hospital, Pretoria, South Africa

Oppel B W Greeff, Department of Pharmacology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

Tracey Hurrell, Department of Pharmacology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

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HIV; Antiretroviral; ARV guidelines

Cite this article

South African Medical Journal 2014;104(7):495-500. DOI:10.7196/SAMJ.7926

Article History

Date submitted: 2014-01-08
Date published: 2014-06-17

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