Rural nurses' antiretroviral prescribing practices in children, Limpopo province, South Africa

Background: Errors in antiretroviral therapy (ART) use are common in children living with HIV (CLHIV), but there is limited evidence from rural primary healthcare (PHC) facilities where trained professional nurses initiate and manage most CLHIV. Objectives: To assess antiretroviral prescribing practices of trained professional nurses in Mopani District's rural facilities and compare them to the 2015 national consolidated guidelines to evaluate the appropriateness of ART use. Method: A four-year (2015-2018) retrospective cross-sectional medical record review was conducted of CLHIV in 94 rural PHC facilities of Mopani District. Inclusion criteria were: age under 15 years, initiated on ART by nurses in 2015 and virally unsuppressed (viral load >= 400 copies/mL) by the end of December 2018. Results: A total of 16 669 antiretrovirals were prescribed from 7035 clinic visits. A correct ART regimen and dosage form was prescribed in 7045 (96%) and 15 502 (93%) of the cases. However, errors were common: 2928 (23%) incorrect doses, 15 502 (93%) incorrect dosing frequencies, and 4122 (61%) incorrectly dispensed antiretrovirals, and 3636 (28%) incorrect dosing frequencies. Conclusion: Antiretroviral prescribing errors in the form of drug omissions in ART regimens, incorrect dosing and dosing frequencies, lack of formulation considerations, and inadequate monthly supplies of antiretrovirals were commonly observed in this review. Antiretroviral stewardship programmes should be considered to develop and establish a fundamental strategy for improving quality in managing CLHIV.