Assessment of Rational Use of Antiretroviral Drugs in Health Institutions in Kano Metropolis

Assessment of Rational Use of Antiretroviral Drugs in Health Institutions in Kano Metropolis

CHAPTER ONE

Objectives Of Study

To determine the different types of antiretroviral treatment programme employed in Kano for management of HIV/AIDS.
To compare the different antiretroviral programme in Kano with the prescribed National Guidelines on antiretroviral.
To determine the accessibility and affordability to antiretroviral therapy in Kano
To determine the level of compliance/adherence to antiretroviral therapy by individual patients in Kano.

CHAPTER TWO

MATERIALS AND METHODS

STUDY LOCATION – KANO

Kano, which is the capital city of Kano State, is located at latitude 12.0⁰N and longitude 8.15⁰E. It is the largest and most populous urban town in Northern Nigeria and is ranked second to Lagos nationally. It has an approximate population of 3.33 million inhabitants with a population density in excess of 250 peoples per square mile (Mathew, 1993).

Demography follows a classical cosmopolitan area. Majority of the people are muslims (more than 90%) and practice polygamy. Kano as a cosmopolitan town is made up of six local governments namely:

Municipal Local Government
Nassarawa Local Government
Fagge Local Government
Dala Local Government
Tarauni Local Government
Gwale Local Government

The town has also overlapped into many communities within the neighboring local governments of Kumbotso, Ungogo and Gezawa Local Governments. The healthcare delivery system consists of two tertiary/teaching Hospitals, two specialist hospitals and seven general hospitals in addition to more than seventy private clinics.

Kano being a highly commercial town, receives visitors and immigrants from other neighboring and far states and even from neighboring countries of Niger, Chad and Cameroon thereby making it rapidly growing and expanding in size.

STUDY SITES

Aminu Kano Teaching Hospital Kano

The present Aminu Kano Teaching Hospital historically proposed at the council of health meeting No. 15 of 1974 came into operation in March 1994 temporarily at Murtala Mohd specialist Hospital. The hospital moved to its present location (permanent site) in July 1997.

Premier Clinic

This is a specialist private hospital offering consultant care in medicine, pediatrics, Obstetric & Gynaecology and urology. The hospital is fully owned and managed by a consortium of indigenous specialist medical practitioners. Because of socio-cultural as well as premium services offered, the hospital maintains excellent patronage from the upper and middle class patients as well as those on retainer ship from their institutions.

The hospital was established in January 1995 at Aminu Kano Way before moving to its present address at No. 8 1^st Avenue Hausawa in January 1997. The hospital now has an average daily patient turn out of about 40.

STUDY DESIGN

The study was conducted as a descriptive cross sectional one.

STUDY POPULATION

The study populations were adults’ confirmed HIV/AIDS patients receiving antiretroviral treatment in the three-selected health institution. The number of patients in each hospital is drawn on a proportionate number of patients in each hospital to the total number of patients put together.

CHAPTER THREE

RESULTS

This case study was carried out covering a period of about four month between October 2003- January 2004. The following table represents the major results of the study.

From Table 3.1 above, the total number of patients that participated in the study were 138. Out of this total, 100 patients representing 72.5% were from Aminu Kano Teaching Hospital, 27 representing 19.5% and 11 representing 8.0% were from Mohammed Abdullahi Wase Specialist Hospital and premier clinic respectively. This level of distribution do not equate with the whole number of HIV/AIDS patients attending those institutions rather represent a proportionate number of HIV/AIDS receiving treatments that are assessable and willing to participate.

Sex Distribution

Analysing Table 3.2 above on the gender distribution among the subject showed that 79 patients representing 57% were males while 59 patients representing 43% were females. The result also analyzed within individual hospital reveals similar pattern with high number of males over females. However the result should not erroneously be used to conclude that more males are infected with HIV/AIDS than females but to only indicate more males are seeking treatment than females.

Age Distribution

From the analysis of the result, the mean age distribution of the subject was 35.6 years with a minimum age of 22 years and maximum age of 55 years while the modal age range is 31-40 years. Also from the study the minimum age of the subject for both males and females was 22 years. The mean age of the female subjects was 31.1 years with a standard deviation of 16.4 while that of males was 39 years with a standard deviation of 7.0.

CHAPTER FOUR

DISCUSSION, CONCLUSIONS AND SUGGESTIONS

The prevalence of HIV/AIDS continue to rise with the result of the 2003 sentinel survey being 5.0% (marginally different for 2001 survey having 5.8%) and also coupled with the increasing number of patients trooping to the clinic everyday seeking treatment either of the clinical syndrome of the disease condition or of the opportunistic infections associated with the disease.

The result of this study carried out to determine among other things, the various antiretroviral treatment programme in some selected health institutions within Kano metropolis, showed that more men are seeking treatment in comparison to women (57% versus 43%). It is equally revealing from the study that the mean age of the population is 35.6 years with a standard deviation of 7.8 years. The modal age range is 31-40years which constitute 41% of the total population.

Based on the findings of the research carried out, the following conclusions can be derived:

HIV/AIDS is pandemic affecting both males and females across both religious groups in It leaves no boundary in the socio-economic strata.
Aminu Kano Teaching Hospital and Premiere Clinic were fully compliant to the Standard Treatment Guidelines of HIV/AIDS patient which recommends the use of highly active antiretroviral drugs (HAART) in a triple combinations while Mohd. Abdullahi Wase Specialist Hospital (MAWSH) was 40% compliant with about 60% on dual nucleoside reverse transcriptase inhibitors therapy. However it is to be noticed that this practice was only at the discretion of the prescribing
Mohammad Abdullahi Wase specialist hospital was not HAART
Adherence to antiretroviral regimen was difficult with about 60% of the patients from the study having ever missed a dose in the treatment schedule. 25% of the patients have missed at least a dose within a week preceding the study. The average number of dose missed is 71 with a standard deviation of 5.4. The minimum dose missed was a dose and the highest been 28 doses (2 weeks doses).
Factors responsible for missed doses were as a result of fasting, cumbersome treatment schedule, forgetfulness, side effects(mainly rashes), stigmatization and unavailability (because they have not filled prescription)
Antiretroviral drugs were available either from a hospital source, a retail pharmacy outlet or directly from manufacturer’s representative. Their affordability was what remained quarry some. About 97% of the patients maintained their readiness to continue affording the drug at the subsidized federal government supply price of one thousand naira (N1000.00) per month whereas only 47.5% of them accepted the possibility of affording the retail price of ten thousand naira only (N10,000.00) per month despite the grave consequences of the disease.

SUGGESTIONS

Although the principal objectives of this study was to determine the level of compliance to the standard treatment guideline by the selected (studied) health institutions, availability and affordability of the various antiretroviral regimen as well as determining the level of adherence to prescribed antiretroviral regimen among the studied population, it still explored opportunity for improvement and confronting the scourge of HIV/AIDS in our local community. The following recommendations are hereby suggested.

There is a need for an improved and proper record keeping towards each patient as an individual in all the health institution
The Federal Government should broaden the subsidized antiretroviral regimen to accommodate more patients as the number of patients dying in the queue of joining the scheme is high because of higher cost of other
The CD4+ and plasma RNA should be monitored more closely at least every three month. This is especially more important for patients receiving treatment outside AKTH.
Federal Government should make available the facility for resistance testing to provide more appropriate the methodology of the choice of salvage
Salvage therapy that will include other new antiretroviral should also be made available to take care of resistance already established with the conventional Lamivudine/Stavudine/Nevirapine Combination.
There is need for increasing campaigns against stigmatizing HIV/AIDS patients such that they can feel free to take medication in other
Patients need to be well informed about their medication and the danger posed by skipping a dose. In fact, they should be properly informed on how to take the medication during fasting.

REFERENCES

Akanmu A.S. (2002). Diagnosis and management of HIV/AIDS. Family Health International (Nig). Training of trainers’ workshop for Doctors on case management of people living with HIV/AIDS PLWHA). Unpublished
Akolo, C., Ukali, C. and Idoku J. (2005). Spectrum of clinical disease at presentation in 200 HIV/AIDS patients of the Jos University Teaching Hospital. 14^th International conference of AIDS and sexually transmitted disease in Africa. December 4-9^th 2005 Abuja- Nigeria.
Anthony Amowoso(2003). .Management of HIV/AIDS. ‘When to start antiretroviral treatment’. Institute of human virology. U.S center for disease control and prevention. Unpublished.
Anthony, S., Fauci, L., (1998). “The human viruses” in the Harrison’s Principle of Internal Medicine. 14^th edition, vol. 2. Mc-Grow- Hill companies. Section 14; PP 1105.
Anjorin, E., Korita, K., Chioma, N. and Biana, S. (2005). Compliance issues associated with antiretroviral treatment in Lumbe , Cameroun. 14^th International conference of AIDS and sexually transmitted disease in Africa. December 4-9^th 2005 Abuja- Nigeria.
Antoni, P. and Brian Gazzard. (2003). British HIV association. Guidelines for the treatment of HIV infected adult with antiretroviral therapy. HIV medicine;4 (suppl 1).

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