Initial antiretroviral treatments for people living with HIV/AIDS attending public health services of Rosario City, Argentina in 2009: which is the degree of accordance with the National Ministry of Health guidelines ?
M.D. Moreira1, E. Rodriguez1, A. Morabito2, D. Lavarello3
1Secretaria de Salud Pública de Rosario, Auditoria de Farmacia, Rosario, Argentina, 2Secretaria de Salud Pública de Rosario, Departamento de Formación y Capacitación Profesional, Rosario, Argentina, 3Secretaria de Salud Pública de Rosario, Programa Municipal de SIDA, Rosario, Argentina
Issues: The request of antiretroviral drugs for people living with HIV/AIDS (PLWHA) to the national program, its reception, and distribution in the Rosario City Health System is a task accomplished by the Pharmacy Auditory Department of the Health Secretary of Rosario. Treatments must be indicated by the treating physicians according to the Argentinian Infectiosus Diseases Society Consensus (guidelines) of year 2007, adopted by the National Ministry of Health. These guidelines include recommended and alternatives drugs as first treatment.
Description: We analyzed the degree of accordance with these guidelines of the initial treatments indicated to the 916 PLWHA under treatment in our health system. We found 368 initial combinations, of which 33 (8,9%)were initiated before the guidelines publication and acceptance. We analyzed the 335 treatments under guidelines, of which 143 (42,7%) are among the recommended combinations, 152 (45,4%) are among the alternative combinations, and 41 (a significative 12,2%) correspond to combinations of drugs not included in the guidelines. A third of them (14) included drugs not recommended now like d4T, indinavir and nelfinavir. The other two thirds (27) included new drugs that according to the guidelines must be clearly justified .
Lessons learned: Even if 88% of the initial drugs combinations were included in the guidelines, the remaining 12% constitutes a problem to be considered from a public health perspective since it may represent the use of unnecessarily harmfull drugs, new drugs indicated because of pharmaceutical companies pressure, with relevant economic consequences, or other situations not clearly identified. This percentage appears like a new indicator to monitor in the public health scenary.
Next steps: We are aiming at a close follow up of this indicator and an open discussion with the treating physicians about the use of the guidelines and the criteria for special drugs or combinations of them.
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