High incidence of antiretroviral prescribing errors in Nigeria

Antiretroviral prescribing errors are common in Nigeria, according to results of a large prospective study published in PLOS ONE. Errors were detected in the prescriptions of almost all adult patients. Common errors included prescribing incorrect antiretroviral drugs or combinations; prescribing drugs that were contraindicated or that interacted with other medication; and inappropriate frequency or duration of therapy.

“The knowledge of incidence rate and types of medication errors identified among HIV-infected patients receiving antiretroviral drugs will be very useful when planning and designing targeted interventions aimed at improving the quality of health care systems in resource-limited settings,” comment the authors. “The study demonstrated that active screening for medication errors is feasible in resource-limited settings.”

HIV care is an unusually complex medical specialism. Antiretroviral treatment is lifelong and regimens typically comprise at least three separate drugs. Moreover, many HIV-positive people are also taking medication for the management of co-morbidities. All this can increase the risk of prescribing errors. Despite this, little is known about the incidence or type of medication errors in resource-limited settings.

Glossary

person years

In a study “100 person years of follow-up” could mean that information was collected on 100 people for one year, or on 50 people for two years each, or on ten people over ten years. In practice, each person’s duration of follow-up is likely to be different.

prospective study

A type of longitudinal study in which people join the study and information is then collected on them for several weeks, months or years. 

capacity

In discussions of consent for medical treatment, the ability of a person to make a decision for themselves and understand its implications. Young children, people who are unconscious and some people with mental health problems may lack capacity. In the context of health services, the staff and resources that are available for patient care.

contraindication

A specific situation or circumstance which means that a drug or medical procedure should not be used because it may be harmful. For example, it may be contraindicated to provide drug A to someone who is already taking drug B.

comorbidity

The presence of one or more additional health conditions at the same time as a primary condition (such as HIV).

An international team of investigators designed a study involving 14 HIV treatment centres in Nigeria. Between 2009 and 2011 the prescriptions of 6882 HIV-positive people were checked for errors. The investigators calculated the incidence and type or errors and also monitored outcomes. Pharmacists were provided with training to improve their knowledge and skills to identify and resolve HIV medication errors.

Approximately two-thirds (67%) of the participants were women and 94% were over 15 years of age. The participants contributed 9172 person-years of follow-up. A total of 110,000 prescriptions were issued, an average of 16 per participant. The total number of drug items dispensed was 306,000.

All the participants were screened for prescribing errors, which were detected for 93% of people aged over 15 years and for 62% of younger people. The overall incidence of prescribing errors was 41 per 100 person-years.

Over a quarter (26%) of errors involved prescribing incorrect antiretroviral drugs or regimens; a fifth involved possible contraindications or interactions; and 17% involved inappropriate duration or frequency of medication.

Nearly all (97%) of the prescribing errors were successfully resolved. In 67% of cases, the pharmacist contacted the prescriber or other healthcare worker to resolve the issue, and in 15% of cases the patient was provided with counselling or education.

“The incidence of medication errors was somewhat high,” conclude the authors. “The study demonstrated that active screening for medication errors is feasible in resource-limited settings following a capacity building intervention.”

References

Agu KA et al. The incidence and types of medication errors in patients receiving antiretroviral therapy in resource-constrained settings. PLOS ONE, 9 (1), e87338, 2014.