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APHA Scientific Session and Event Listing

Laila Akhlaghi, PharmD, MPA, Rational Pharmaceutical Management Plus Program, Management Sciences for Health, 4301 North Fairfax Drive, Arlington, VA 22203, 011 703 524-6575, lakhlaghi@msh.org

The Rational Pharmaceutical Management Plus Program analyzed ART regimens and consumption data in Cote d'Ivoire, Ethiopia, Haiti, Kenya, Namibia, Rwanda, and Zambia to provide baseline data for an international effort to forecast global ARV needs to 2010; additionally, patterns of ART regimen use can also shed light on the rational use of ARVs.

The prescription data analyzed were based on 71,550 adults and 5,828 children on ART. Consistent with 2003 World Health Organization guidelines, stavudine or zidovudine, plus lamivudine plus nevirapine, or efavirenz were counted as first-line treatments. Use of any other ARV represented second-line treatments. RPM Plus calculated the percentage of adult and pediatric patients on first- and second-line regimens and the distribution of individual ARVs and all protease inhibitors by regimen.

Overall, the seven countries had 76 different adult treatment regimens and 31 pediatric regimens. However, about 95% of both adult and pediatric patients were on WHO first-line regimens except in Cote d'Ivoire (possibly due to HIV-2 infections) and Haiti, where only 63% of adults and 69% of children, respectively, followed WHO recommended treatments. The data on individual ARVs showed similar trends.

Worldwide ARV usage harmony and compliance with WHO guidelines make it easier to estimate future drug needs; help reduce costs by facilitating joint procurement and reducing product prices; and decrease the emergence of ARV resistance, thereby preserving future treatment options. Although these seven countries include many regimens in their ART policies, they are generally abiding by WHO's four recommended guidelines for almost all of their patients.

Learning Objectives: