Assessment Of The Compliance Of Private Health Care Providers To Guidelines For Antiretroviral Therapy In The Management Of Hiv And Aids Patients In Windhoek, Namibia

ABSTRACT

Since the identification of the first human immunodeficiency virus (HIV) case, developments have been underway to find treatment for the virus. Antiretroviral agents, especially when used in highly active antiretroviral therapy (HAART) regimens, have produced dramatic decreases in morbidity and mortality of HIV infected people and has made HIV a potentially treatable chronic disease. The success of HAART depends on the correct combination of drugs and on adherence to the treatment regime. In April 2003, the Ministry of Health and Social Services published the first antiretroviral treatment guidelines which form the basis of HIV management in Namibia. However the actual availability of these guidelines and their application in the private sector was not known. This study was conducted to determine the availability of Namibia Guidelines for Antiretroviral Treatment in the private sector and to assess the proportion of private health care providers who comply with the guidelines. A survey to determine the practices of doctors and pharmacies providing ART services in the private sector in Windhoek, Namibia, was conducted, using the Ministry of Health Guidelines for Antiretroviral Therapy, a standard against which the private sector practices were measured. The results of the study showed a general awareness (96% for doctors and 81% for pharmacists) and availability (92% for doctors and 50% for pharmacists) of MoHSS v guidelines. The overall proportion of private healthcare providers who adhere to guidelines is small although some aspects of the guidelines such as when to start therapy (61%), what to start with (96%), when to change (100%) and what therapy to use (73%) are well adhered to by doctors. The majority of the pharmacists (58%) do not dispense in accordance with the guideline recommendations. This study has uncovered a wide diversity of practice in the different aspects of HIV management and significant deviations from the Namibia guidelines for antiretroviral therapy, first edition.