Publication:

Rational medication use review: a quality assurance/improvement process for HIV/AIDS treatment programmes

Background A Rational Medication Use Review (RMUR) was conducted at four facilities providing antiretroviral therapy in Burundi as a simple and practical strategy for service providers and programme managers to continuously assess and monitor quality of ART services provided.

Methods A comprehensive data collection tool was developed to systematically and retrospectively capture relevant data from randomly selected ART patient files in the four ART facilities.

Results ART data from 157 patients receiving ART services from four facilities was extracted and analysed. WHO stage 4 AIDS defining diseases were recorded in 125 (79.6%) of the patients at the time of ART initiation. The most frequent opportunistic infections and/or co-morbidities were cryptosporidiosis (14.4%), HIV wasting (14.4%), tuberculosis (13%) and candidiasis (17.4%). 97.8% of the patients were taking concomitant medicines. A large percentage of patients (72.4%) had done a baseline CD4 test before initiation of therapy with a majority of the patients (85.8%) getting their lab results within one week of the collection of the specimens. For some patients (9%), it took up to 8 weeks to get test results. About 21.8% of the patients were hospitalized at least once while on ART and 11.2% of the hospitalized patients died.

Conclusion " RMUR is a simple and practical strategy that can be appropriately modified to suite local settings. It offers a cost-effective and participatory method of identifying and correcting factors that may negatively impact the quality of care and desired outcomes for patients on ART.