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Monitoring Clinical Practice of Antiretroviral Therapy Program at the Macro Level: Comparison of Logistics Management Information Records and Supply-Based Estimations in 194 PNFP Health Facilities, Uganda 2012-2013

Sunday, November 1, 2015

Ben Davis, Axios International, Paris, France
Sowedi Muyingo, Medical Access Uganda Limited, Kampala, Uganda
Rashid Settaala, Medical Access Uganda Limited, Kampala, Uganda
Eric Nabuguzi, Medical Access Uganda Limited
Faith Mbabazi, Medical Access Uganda Limited
James Olweny, Medical Access Uganda Limited
Paul Lotay, Medical Access Uganda Limited
BackgroundAntiretroviral (ARV) therapy has become widely available across the African continent. However, typical methods for tracking medication use, such as those based on patient records, can lack reliability. This study proposes an alternative method for monitoring clinical practice using ARV supply data.

MethodsThe analysis included 581 reports from 194 Ugandan private-not-for-profit (PNFP) health facilities supplied by Medical Access Uganda Limited between October 2012 and September 2013. Data included ARV quantities supplied to adults and children as well as reported number of clients that were treated.

Supply data was compared with the number of existing patients reported. Correlation and agreement were assessed using Pearson's correlation coefficients and Bland-Altman plots respectively. Results were stratified by patient age group (adult, child), regimen class (first- or second-line). For children, a series of hypotheses were tested in relation to average body weight and body surface area (5 kg-20 kg, 0.2 m2 - 0.7 m2).

Results: For adult cases, a correlation was found between the number of patients estimated using supply data (cumulative 845,042 person-months [PM]) and the number reported in the health facility reports (827,189 PM; r= 0.889, p < 0.00001). For children, there was poor agreement demonstrated by lower correlation coefficients (r from 0.641 to 0.674, p < 0.00001) and Bland-Altman plot (mean bias per report -72 [-55.9%]). 

Conclusions: Supply data is often more consistent and readily available, these preliminary findings underline the important and complementary role that supply-side data could play in regular monitoring of ARV treatment programs.

Learning Areas:

Basic medical science applied in public health
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health administration or related administration
Public health or related research

Learning Objectives:
Describe an alternative method for monitoring clinical practice using ARV supply data.

Keyword(s): Adherence, Pediatrics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I'm the Executive Director of Medical Access Uganda Limited a health commodity supply chain management organization with over 16 years experience. I hold a Masters in Public Health (MPH), Masters in Business Administration (MBA) and Bachelors' degree in Pharmacy (BPharm.)
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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