A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance.

There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.

Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance.

INTRODUCTION: Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. AREAS COVERED: A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. EXPERT OPINION: ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.

Tracking adverse drug reactions and medication errors in the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme in South Africa.

Background: The South African Central Chronic Medicine Dispensing and Distribution (CCMDD) programme is a National Health Insurance (NHI) initiative that improves access to medicine for patients. Objectives: To describe the frequency of adverse drug reactions (ADRs) and medication errors reported in stable patients living with HIV. Method: This descriptive cross-sectional survey was conducted from August 2020 to October 2020, targeting tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) and tenofovir disoproxil fumarate/emtricitabine/efavirenz (TEE) patients. The distribution of ADRs and medication errors is presented. Results: Of 9621 patients, 30.8% (n = 2967) were interviewed, 40.2% (n = 1192) on TLD and 59.8% (n = 1775) on TEE regimens. The majority were women (TLD: 55.8%, n = 665; TEE: 75.4%, n = 1338); 15% (179/1192) reported ADRs on TLD. Medication errors were low on TLD (1.6%, n = 19) and TEE (1.2%, n = 22). Receipt of incorrect medication (eight each in TLD and TEE) and associated hospitalisations (one vs two, respectively) were low. Common TLD-associated ADRs were weight gain (47.5%, n = 85), headaches (44.7%, n = 80), insomnia (39.7%, n = 71), restlessness (36.9%, n = 66), dizziness (29.6%, n = 53), brain fog (27.9%, n = 50), nervousness (27.4%, n = 49), rash on the skin (24.6%, n = 44) and poor concentration (21.2%, n = 38). Conclusion: About one in seven patients reported ADRs under TLD. Medication errors were low, possibly due to effective quality control measures and stable patients being on the programme. Knowing the frequency of ADRs and medication errors is critical for enhancing the CCMDD programme.

Factors associated with retention in HIV care at Sediba Hope Medical Centre.

BACKGROUND: Lost to follow-up (LTFU) is a major challenge that hinders the success of antiretroviral treatment (ART). OBJECTIVE: To identify factors conducted to a low LTFU rate. METHODS: We conducted a two-part descriptive and quantitative study. Part 1 comprised interviews with clinic staff to determine their perspectives on LTFU and to establish the clinic's follow-up procedures for patients on ART. Part 2 of the study was a retrospective review of clinic and patient records. LTFU patients were identified and those with contact details were contacted for telephonic interview to determine if they were still on ART and/or their reasons for becoming LTFU. RESULTS: A low LTFU rate (7.9%; N = 683) was identified. Work-related stress, and lack of transport and funds were reported reasons for LTFU. Monthly visits, non-adherent defaulters and LTFU patients were tracked by an electronic system (SOZO). Factors contributing to high rates of retention in care were: location of the clinic in the inner city, thus in close proximity to patients' homes or work; clinic operating on Saturdays, which was convenient for patients who could not attend during the week; an appointment/booking system that was in place and strictly adhered to; a reminder SMS being sent out the day before an appointment; individual counselling sessions at each visit and referrals where necessary; and a stable staff complement and support group at the clinic. CONCLUSION: Achieving a low LTFU rate is possible by having a patient-centred approach and monitoring systems in place.