Factors before enrolment are associated with being removed from a pharmacy-only refill program at a large urban HIV/AIDS clinic, Uganda

Background: A Pharmacy-only Refill Program is a type of task shifting in which stable HIV-positive patients are managed through pharmacy-only visits instead of physician visits. The purpose of this study was to identify factors for being removed from the Pharmacy-only Refill Program in order to establish better referring criteria. Methods: The study was performed at the Infectious Disease Clinic in Kampala, Uganda. We selected a random sample of 588 patients from 2431 patients on antiretroviral therapy referred to the Pharmacy-only Refill Program at least 12 months before commencement of the Pharmacy-only Refill Program evaluation. We compared the characteristics of patients who during 12 months of follow-up were removed from the Pharmacy-only Refill Program with those who continued to be followed up. Data were abstracted from the IDC data base, the pharmacy register and the patient clinical notes.ResultsOf 588 patients, 106 (18%) were removed from the Pharmacy-only Refill Program. In multivariate analysis, less than 100% self-reported adherence to antiretroviral therapy, missing at least one scheduled appointment in the six months before referral to the Pharmacy-only Refill Program and being on a lopinavir/ritonavir-containing regimen were independently associated with being removed from the Pharmacy-only Refill Program. Conclusion: Criteria for referring patients to a Pharmacy-only Refill Program should focus on antiretroviral therapy adherence and appointment keeping. Patients on a lopinavir/ritonavir-containing regimen should not be targeted for a Pharmacy-only Refill Program. A Pharmacy-only Refill Program on the other hand is an efficient strategy that targets stable adherent patients in clinics with high patient load.