Adoption of new HIV treatment guidelines and drug substitutions within first-line as a measure of quality of care in rural Lesotho: health centers and hospitals compared

N.D. Labhardt, M. Sello, T. Lejone, J. Ehmer, M. Mokhantso, L. Lynen, K. Pfeiffer

Research output: Contribution to journalA1: Web of Science-article

Abstract

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.
Original languageEnglish
JournalTropical Medicine and International Health
Volume17
Issue number10
Pages (from-to)1245-1254
Number of pages10
ISSN1360-2276
DOIs
Publication statusPublished - 2012

Keywords

  • Viral diseases
  • HIV
  • AIDS
  • HAART
  • Antiretrovirals
  • Quality of care
  • First-line drugs
  • Treatment guidelines
  • National policies
  • Drug policy
  • Substitution
  • Tenofovir
  • Zidovudine
  • Stavudine
  • Lamivudine
  • Health centers
  • Hospitals
  • Compliance
  • Acceptability
  • Lesotho
  • Africa-Southern

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