Browsing by Author "Ward, Kim L."

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    Examining the inventory management of antiretroviral drugs at community health centres in the cape metropole, Western Cape
    (2013) Mahoro, Alice; Ward, Kim L.
    South Africa is faced with a high number of people living with HIV/AIDS, and subsequently a great need to access quality medicines for improving patient therapeutic outcomes. Antiretroviral drugs (ARVs) require rigid, efficient and effective management, due to their valuable efficacy in prolonging the survival of HIV/AIDS patients, and the limited possibility of substitution. Managing their flow is vital to ensure an uninterrupted supply. Problematic inventory management was experienced by some healthcare facilities in South Africa where in recent years it resulted in stock outs and stock losses through thefts. These factors present obstacles to the availability of quality medicines, which ultimately leads to treatment failure and deterioration of the health status of patients. The aim of this study was to characterise the inventory management practices and medicine store maintenance of ARVs in community health centres (CHCs) in the Cape Metropole, Western Cape, in order to identify specific problems associated with ARV stock management. The study used a descriptive, cross-sectional study design to examine ARV records and to highlight associated discrepancies between recorded iii quantities on logistics tools used and physical counts, to assess the store maintenance, to measure the supply rate and identify factors contributing to poor stock management. The sample comprised 15 CHCs under the Western Cape Provincial Government (WCPG) accredited to provide ARV treatment. A checklist developed by Management Sciences for Health was adapted and was used to gather quantitative information (e.g. physical stock count). Some qualitative data was collected from responsible personnel for ARV drug management at each site. 86.7% of CHCs utilised a logistics tool (either manual or electronic) to manage ARVs. The average number of adult ARV drugs with a logistics tool available in all CHCs was 82.7% of which 21.9% met the criteria for accuracy. Only 32.9% of all logistics tools had records that were up to date. The average percentage of total variation between stock records and physical counts for the ARV drugs assessed was 51.6%. No historical data on stock outs and monthly usage (monthly consumption) could be retrieved in any of the CHCs, although there were no actual stock outs on the day of the fieldwork. The order fill rate was 91.9%. Since ordering is done more often that it should, stock availability did not appear to be problematic. Standard appropriate physical dimensions were not met by 20% of the CHCs and only 66.7% of the CHCs had appropriate labeling of the shelves in the dispensary and in the storeroom. This study demonstrated poor inventory management with respect to the general quality of record keeping, space allocation and general organisation of the medicine storeroom. Making timely entries and recording issues on logistics tools are recommended to keep up to date inventory records and management information system. Frequent monitoring of stock status is suggested, to avoid discrepancies and to keep it to adequate levels iv which will minimise multiple ordering. Regular supervision by the district pharmacist is needed to identify training and other needs. A study on general cost and delivery costs associated with poor record keeping should be carried out.
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    Monitoring lipid and haematological abnormalities in paediatric patients on antiretroviral therapy at a Community Health Centre in the Cape Metropole
    (University of the Western Cape, 2014) Nambatya, Winnie; Ward, Kim L.; Mugabo, Pierre
    South Africa faces a huge Human Immunodeficiency Virus (HIV) burden with more than 400,000 children currently on antiretroviral therapy (ART). Studies on lipid and haematological profile changes in paediatrics are of particular interest since these children are exposed to ART in the course of a developmentally significant period and will possibly have longer collective exposure to ART. As such, monitoring for adverse effects, including lipid and haematological abnormalities, is essential for curtailing morbidity and mortality rates of children on ART. There is a dearth of studies assessing lipid and haematological abnormalities in the South African paediatric population on ART where genetic differences, co-morbidities, malnutrition and use of traditional medicines, all influence the safety profile of a drug. The goal of this study was twofold: Firstly to identify a suitable parameter for assessing lipid and haematological abnormalities in paediatrics on Antiretroviral (ARV) treatment using available secondary data and secondly, to assess prescriber adherence to routine monitoring tests in the ART guidelines. This study was a retrospective review of secondary data obtained from 168 patient clinical records at a Community Health Centre in the Cape Metropole, Western Cape and corresponding laboratory data from the National Health Laboratory Service (NHLS) database. Appropriate cholesterol, triglyceride, haemoglobin and neutrophil test results were compared against the standard reference ranges/values. The Chi-Squared test identified associations between total cholesterol (TC) /triglycerides and haemoglobin (Hb)/neutrophil and other independent variables. Evaluation of health care provider adherence to routine monitoring tests was assessed against relevant national ARV management guidelines. There was a paucity of baseline data for all laboratory markers and infrequent follow-up tests were ordered by healthcare providers. This precluded the measurement of changing lipid and haematological levels and an alternative parameter, viz., the highest available laboratory test value for each marker per patient, was assessed against reference values/ranges. Only nine out of the 36 (25%) patients on an AZT regimen had any Hb or neutrophil laboratory tests performed and 23 and two out of 97 (24% and 2%) patients, respectively, on a protease inhibitor (PI) had a TC and triglyceride laboratory test performed. Anaemia was detected in 45.5 % of children below five years of age, in 21.7% between ages of six and 11 and in 65.5 % between 12 and 14 years of age. Neutropenia was detected in 25.6% of children below five years of age and in 50% aged between six and 11. Hypercholesterolemia was found in 13.1% of patients. The only statistically statistical associations were found between the TC and CD4 count in children aged six to 14 years (χ2=5.000; p=0.025) and between neutrophil counts and viral load in children aged six to 14 years (χ2=6.4532; p=0.0240). A significant association was also found between Hb levels and viral load (χ2=7.000; p=0.008). In the absence of baseline test results and routine monitoring of haematological and lipid profiles, this study presents a potential alternative marker for assessing lipid and haematological abnormalities using the highest level of neutrophil, Hb, TC and triglycerides recorded for each patient.