Abstract:
Background: Recent studies have reported on-time antiretroviral (ART) drug pick-up, the fourth Early Warning Indicator (EWI) described by World Health Organization (WHO) to be the strongest predictor of clinic-level viral load suppression. The primary objective of this study was to assess the impact of pharmacist counselling at the point of late ART refill and identify modifiable predictors for refill non-adherence.
Methods: A cross sectional study was conducted among 691 Malaysian HIV-infected individuals receiving ART from May 2019 until July 2019. Patients with late refills were actively absorbed for a comprehensive counselling session and follow-up pharmacy refills were evaluated using medication possession ratio (MPR) for duration of 6 months. MPR of more than 90% was categorized as optimal refill adherence. Paired T-test was used to test the effectiveness of counselling at late refills whilst multivariate regression models were used to examine predictors of late refills.
Results: Among 691 HIV-infected patients, 85% had on-time refills. Patients with late refills (n= 101) were predominantly male (88%). Mean age was 40 years and mean duration on ART was 4 years. Work commitment accounted for the highest reasons for late refills (25.7%) followed by intentional poor adherence (23.7%). Identifying patients and providing counselling at late refills, increases MPR or refill adherence significantly in patients who had
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previously poor MPR scores (MD=14.43; SD= 13.14; p <0.001). Multivariate binary logistic regression analysis found history of self-reported non-adherence (AOR= 0.259; 95% CI [0.119 -0.563]; P<0.001) travelling more than 20km to the hospital (AOR= 0.184; 95% CI [0.079-0.427]; p< 0.001) and having medication possession ratio percentage of less than 90 % (AOR= 0.141; 95% CI [0.067-0.296]; p< 0.001) were significant predictors of late refill.
Conclusion: The proportion of patients with on-time drug pick up was only a fair performance according to World Health Organization standards. Our study further suggests integration of identifying and counselling patients with late refills as part of the dispensing process as it increases pharmacy refill adherence significantly. This targeted intervention could serve as an early proxy of retention in care especially in resource-limited settings.
Keywords: On-time drug pick-up, adherence, medication possession ratio, refill adherence, antiretroviral drugs
