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

Background: Antiretroviral (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.

Methods: The 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.