Exploring the delivery of antiretroviral therapy for symptomatic HIV in Swaziland: threats to the successful treatment and safety of outpatients attending regional and district clinics

被引:7
作者
Armitage, Gerry [1 ,2 ]
Hodgson, Ian [2 ]
Wright, John [1 ]
Bailey, Kerry [3 ]
Mkhwana, Estel [3 ]
机构
[1] Bradford Royal Infirm, Bradford Inst Hlth Res, Yorkshire Qual & Safety Res Grp, Bradford BD9 6RJ, W Yorkshire, England
[2] Univ Bradford, Sch Hlth, Bradford BD7 1DP, W Yorkshire, England
[3] Good Shepherd Hosp, Siteki, Swaziland
关键词
HEALTH-CARE; PRESCRIBING ERRORS; DISPENSING ERRORS; MEDICATION ERRORS; RISK-FACTORS; SYSTEMS; AFRICA; UK;
D O I
10.1136/bmjqs.2009.034512
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Aim: To examine the safety and acceptability of providing antiretroviral therapy (ART) in a resource poor setting. Design: Two-stage observational and qualitative study. Setting: Rural hospital in Southern Africa. Methods: Structured observation using failure modes and effects analysis (FMEA) of the drug supply, dispensing, prescribing and administration processes. The findings from the FMEA were explored further in qualitative interviews with eight health professionals involved in the delivery of ART. To obtain a patient perspective, a stratified sample of 14 patients receiving ART was also interviewed. Results: Key vulnerabilities in the process of ART provision include supply problems, poor packaging and labelling, inadequate knowledge among staff and lack of staff. Key barriers to successful patient adherence include transport inconsistency in supply and personal financial difficulties. There is, however, strong evidence of patient commitment and adherence. Implications and conclusion: Medication safety is relatively unexplored in the developing world. This study reveals an encouraging resilience in the health system and adherence among patients in the delivery of complex ART. The vulnerabilities identified, however, undermine patient safety and effectiveness of ART. There are implications for drug manufacturers; international aid agencies funding and supplying ART; and local practitioners. FMEA can help identify potential vulnerabilities and inform safety improvement interventions.
引用
收藏
页码:52 / 59
页数:8
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