Access to essential medicines for managing opportunistic infections among HIV/AIDS patients in Dar-es-Salaam regional hospitals, Tanzania.

Abstract

Background: Insufficient access to essential medicines for managing opportunistic infections in CTC clinics and high medicines prices in the private pharmacies are still the leading problems in the management of opportunistic infections among HIV patients. In Tanzania and other East African countries, little is documented regarding the access of essential medicines for treatment of opportunistic infections at the patient level. Findings from this study are important for decision makers in developing effective policies and provide equitable access to essential medicine for managing opportunistic infections. Objective: The main objective of this study was to assess the access of essential medicines for managing opportunistic infections among HIV/AIDS patients in Dar-es-salaam regional hospitals. Methods: A cross-sectional study was conducted among selected HIV/AIDS patients, pharmaceutical personnel at three CTC clinics (Amana, Mwananyamala and Temeke) and 6 private pharmacies. Data was collected by using adopted WHO/HAI methodology. Median price of these medicines were compared with International Reference Price. The salary of the lowest-paid un-skilled government worker and National Poverty Line income was used to assess affordability of essential medicines for managing OIs. Data was analyzed by using EPI Info version 3.5.4. Chi-square test was used to test for statistical significance of the observed results. Results: This study enrolled 305 participants with a mean age of 41 years, of which more than 59% earn below TZS 5,500 per day. The selected common OIs found were respiratory tract infection (RTI), skin fungal infection (SFI), urinary tract infection (UTI) and oral candidiasis (OC), and common prescribed medicines were Amoxycillin 250mg capsules, Ciprofloxacilin 500mg tablets , co-trimoxazole 480mg tablets, fluconazole 150mg tablets and Clotrimazole 1% cream. The availability of medicines for managing opportunistic infections in the CTC clinics were found to be very low about 15%, 17% and 24% for Mwananyamala, Temeke and Amana CTC respectively. Most of the patients have inadequate ability to purchase medicines due to high price in the private pharmacies, (MPR=2.605), of which patients need to utilize up to more than 5 working days of for those patients who are living below poverty line (TZS 2000) need to work for about 12 days‟ wages in order to pay for a one-treatment dose of an essential medicines. . Lowest unskilled government employee to purchase a minimum dose, while

Conclusion and recommendations: The study reveals poor accessibility of essential medicines for managing opportunistic infections in the CTC clinics. The prices of medicines are very high for majority of HIV/AIDS patients to have ability to pay for medicines. Therefore the availability, pricing and affordability of essential medicines should be improved in order to ensure equity in access to medicines among HIV/AIDS patients in CTC clinics among referral hospitals in Dar-es-salaam. Through adopting health financing system and universal health coverage approach at the CTC clinics, consideration of other alternative strategies for controlling measures of essential medicines availability, prices and drug subsidation in the private pharmacies will make these medicines readily available and affordable by the majority of the HIV patients.