Following implementation of routine annual HIV-1 RNA monitoring at the Infectious Diseases Institute HIV clinic (Kampala, Uganda), a Pharmacy Refill plus Program (PRP) was introduced to reduce patient visit loads on doctors and nurses by incorporating pharmacy-only visits in patient monitoring algorithms. The PRP patients would have only 4 visits in a year(every 3 months) alternating a doctor visit and a pharmacy-only visit to pick up their drugs as opposed to standard of care where a doctor or nurse would be seen every 2 months. The PRP schema comprised: doctor visit (enrollment), pharmacy-only visit (month 3), doctor and adherence counseling visit (month 6), pharmacy-only visit (month 9), doctor visit (month 12). Patients were included into the PRP if they were stable on first-line antiretroviral therapy for at least 24 months, and had no opportunistic infections or non-communicable diseases. Pregnant women were excluded.
Between 10Aug15 and 23Sep16, 708 patients were screened of which 624 patients met program criteria. A cross sectional analysis was conducted including 288 patients who had at a minimum completed the month 3 visit. Data was extracted from the IDI electronic medical record (Integrated Clinic Enterprise Application) database and clinical records of patients that dropped out of the PRP were examined in detail by one reviewer. Median duration of time for patients to be dropped off the program for any reason and the proportion of patients with HIV-1 RNA suppression was calculated.
Overall among patients enrolled; 354/624(56.7%) were females with median age 46[Interquartile range(IQR) 40-51] years and median CD4 492(IQR 367-653) cells/ul. Only 2/288 patients were discontinued from the program due to NCD diagnoses at months 3 and 11 resulting an overall retention at 99.3%. Median time among those on program was 11.1(IQR 5.0-12.4) months and 6.95(IQR 3.2-10.7) months among those who discontinued. Of the 84/624 completed a month 12 visit, 83/84(98.8%) had viral suppression at month 12.
Implementing a monitoring approach and incorporating pharmacy-only visits for stable patients was feasible in Infectious Diseases Institute HIV clinic (Kampala, Uganda). High retention rates and virologic suppression rates suggest that this approach should be considered for wider implementation