Abstract:
BACKGROUND: Self-initiation to antiretroviral treatment (ART) exposes the patient
to the risk of drug toxicity, poor adherence to treatment, and escalates the
development of drug resistance.
OBJECTIVES: To determine the sources of antiretroviral (ARV) drugs by
unregistered human immunodeficiency virus (HIV)-infected patients and the extent
of ARV self-medication.
METHODS: Simulated clients were used to investigate availability and ARV
dispensing practice in the private pharmacies in Dar Es Salaam, Tanzania. A total
of 480 HIV-infected patients qualifying to start ART were interviewed to find out
their previous use of ARV drugs prior to visiting the HIV clinics. Venous blood
(2 mL) was collected from each patient who indicated not to have used ARVs in the
past (n = 450). Blood samples were analyzed for the presence and levels of
nevirapine (NVP).
RESULTS: Only 5.1% (23/451) of pharmacies were found stocking ARVs drugs, among
which 4.0% were retail. Drug dispensers in nearly all (15/18) retail pharmacies
which stocked ARVs were willing to sell ARVs without prescription. Out of 450
enrolled patients, only 2.7% (12) stated that they had been receiving ARV drugs
from HIV clinics but interrupted the ART treatment due to various reasons. From
450 patients, only 10% had quantifiable NVP concentrations in the blood, despite
stating in an interview that they had not recently used ARVs.
CONCLUSION: Prior use of ARV drugs outside HIV clinics was rare among patients
attending those centers. However, the results show that some patients could
access and use ARV drugs from private pharmacies without undergoing ART
eligibility assessment in HIV clinics.
