Increasing the proportion of eligible clients enrolled on the Community Retail Pharmacy Drug Distribution Point (CRPDDP) Model at Mulago Immune Suppression Syndrome (ISS) Clinic.
In January 2022, NM, a 32-year-old Female, from Mukono located 20 kilometers east of Kampala visited the Mulago ISS clinic to pick up her ARVs. While at the patient-waiting area, she heard about the CRPDDP model and she picked interest. She was counseled, given information on the CRPDDP model, and screened for eligibility to join the CRPDDP model. Despite being eligible, NM was worried that joining CRPDDP could be one way of eliminating her from the clinic and she wondered if she was to receive similar services from a community pharmacy. The counselor allayed her fears and reassured her of the continuity of quality services and the benefits of the CRPDDP model. She then decided to be enrolled in the CRPDDP model that day. “If I can be able to pick my medicines any time even on weekends, it will help me,” says NM"
The Ministry of Health Uganda aims to improve access to ART for persons living with HIV (PLHIV) through Interventions tailored towards addressing the barriers to sustainable delivery of ART and HIV care services. The Ministry adopted the Differentiated service delivery approaches, among which is the Community Retail Pharmacy Drug Distribution Point (CRPDDP) model, where eligible PLHIV (Stable, virally suppressed, not pregnant or lactating, not co-infected with TB or other comorbidities, > 20 years, At least 1year on ART) get ART refills from a designated community retail pharmacy. CRPDDP improves ART accessibility of clients with flexible working hours, reduces stigma, and reduces the workload for health workers to focus on unstable clients and offer quality care.
Continuous quality improvement project: A review of patient records in December 2021 at the Mulago ISS clinic from Uganda showed that of the about 16050 PLHIV receiving care at the clinic, 15392 were eligible for CRPDDP (on ART for at least a year, virally suppressed, not pregnant, not co-infected with TB or other co-morbidities, above 20 years). The clinic had a programmatic target of enrolling at least 4,000 eligible PLHIV on CRPDDP by September 2022. However, only 117 (2.9 %) of the targeted 4000 PLHIV were enrolled by the of start December 2021 which was suboptimal. Through brainstorming and using the 5-WHYs technique, the CRPDDP team (Counselors, Doctor, peer educator, Pharmacy Technician, and Data officer) identified the gaps and root causes of suboptimal enrollment as; Staff and client knowledge gap on the CRPDDP model, Stigma, and associated clients' fears, and unspecified roles for the team members. The correction measures commenced with staff CMEs and sensitization of clients through daily health talks. A monthly enrollment target of 388 PLHIV were set, and a focal counselor closely monitored daily progress. Because of these interventions, there was a cumulative improvement in the number of eligible PLHIV enrolled in CRPDDP as demonstrated in the graph below.
The Challenges that the health facility faced included; a lack of synchronization of the ART Access (an m-Health tool that links information for patients on ART and their viral load to an algorithm, which guides a community pharmacy in dispensing) with the Uganda Electronic Medical Records (EMR) sometimes leading to inconsistent data for reporting.
To ensure the delivery of high-quality ART services at the retail community pharmacies we conducted monthly on-site mentorships of the community pharmacy teams on how best to serve the PLHIV that present for refills at these pharmacies and on the use of the ART Access system for dispensing
NM A patient at Mulago ISS on CRPDDP who works in Mulago as a waitress says,” I have been on ART for 4 years but my job would not give me time to pick my ARVS since I work from 5 am to 6 pm and I would reach late at the facility when they have closed and hence missing my appointments. After my counselor explained to me about CRPDDP, I picked interest and joined. This has helped me balance work and health visits since can pick up my ART refills after work from the pharmacy, sometimes on weekends. Thank you so much MJAP.