Asking PLWH in sub-Saharan Africa about how their care could be improved led to identifying meaningful propositions. According to experts, half of the ideas identified could be implemented easily at low cost for minimally disruptive HIV care.

Background While antiretroviral treatment (ART)-related adverse drug reactions (ADR) are documented in industrialized countries, there is no pre-existing surveillance system dedicated to ADR monitoring in most African countries. We assessed knowledge towards pharmacovigilance among ART prescribers and available capacity of HIV clinics to conduct ADR monitoring in Abidjan, Côte d’Ivoire. Methods A questionnaire was administered to ART prescribers, to assess their knowledge towards the occurrence of ADRs. A retrospective ADR survey was also conducted, based on a data query of treatment modification/interruptions in three HIV clinics. Clinical monitors went back to medical charts to review and validate the reasons of the treatment modification/interruptions. Results Of the 81 ART prescribers interviewed, 25 (31%) declared not grading ADRs and 12 (14.8%) declared notifying ADRs to the national regulatory authorities. Among 5,252 adult ART-treated patients who attended the participating clinics in 2008, 599 treatment modifications were identified. Reasons for treatment modification/interruptions identified in the electronic database were documented in the medical charts in 554 (92.5%) cases, ADR accounting for 273 (45.5%) cases. Toxicity related to ART was graded in only 58 (21%) cases in the medical charts. Discussion This study describes challenges limiting the implementation of reliable pharmacovigilance activities in HIV clinics in Côte d’Ivoire. The lack of knowledge of ART prescribers concerning ADR grading does not support the spontaneous reporting of ADRs. Using treatment modification/interruptions for ADR monitoring appears feasible but improvements are needed to respond to key questions related to drug toxicities in the context of ART scale up in Africa.

ObjectivePeople living with HIV infection (PLWHIV) in Sub-Saharan Africa cope with an increasing workload of care (doctor visits, lab tests, medication management, refills, etc.) in a context of poor health service organization. We aimed to describe the workload of care for PLWHIV in Sub-Saharan Africa and assess to what extent simple adjustments in care organization could reduce this workload of care.MethodsAdult PLWHIV under antiretroviral treatment for at least 1 year were recruited in three centers (two public, one private) in Abidjan, Côte d’Ivoire. Using methods inspired from sociology, we precisely described all health-related activities (HRAs) performed by patients, in 1 month, in terms of time, money and opportunity costs. Then, we assessed the theoretical avoidable workload of care if patients’ visits and tests had been grouped on the same days.ResultsWe enrolled 476 PLWHIV in the study. Patients devoted 6.7 hours (SD = 6.3), on average, in HRAs per month and spent 5% (SD = 11) of their monthly revenue, on average, on health activities. However, we found great inter-patient heterogeneity in the mixture of activities performed (managing medications; dietary recommendations; visits, tests, support groups; administrative tasks; etc.) and their time allocation, temporal dispersion and opportunity costs (personal, familial, social or professional costs). For 22% of patients, grouping activities on the same days could reduce both time and cost requirements by 20%.ConclusionPLWHIV in Côte d’Ivoire have a heavy workload of care. Grouping visits and tests on the same days may be a simple and feasible way to reduce patients’ investment of time and money in their care.

BackgroundIn Côte d’Ivoire, people living with HIV (PLHIV) have free access to antiretroviral therapy (ART) and cotrimoxazole. Yet, they may use other medications to treat non-HIV diseases. Scarce data are available regarding the use of non-HIV medications in Africa. This study describes the use of non-HIV medications and identifies the factors associated with their use by PLHIV on ART in Côte d’Ivoire.MethodsA cross-sectional study was conducted in six HIV clinics in 2016. HIV-1-infected adults receiving ART for at least one year were eligible. A standardized questionnaire was used to collect demographics, HIV characteristics and medication use data. Associated factors were identified using a multivariate adjusted Poisson regression.ResultsA total of 1,458 participants (74% women) were enrolled. The median age was 44 years, and the median duration of ART was 81 months. A total of 696 (48%) participants reported having used at least one non-HIV medication. Among the 1,519 non-HIV medications used, 550 (36%) had not been prescribed and 397 (26%) were from the nervous system class. Individuals who were more likely to report the use of at least one non-HIV medication included those who had been treated in an Abidjan HIV clinic, had a high school education level, had a monthly income between 152 and 304 euros, had a poor perceived health status, had WHO advanced clinical stage, had used traditional medicine products and had not used cotrimoxazole.ConclusionAlmost half PLHIV on ART reported using non-HIV medication. Further research is needed to assess whether the use of non-HIV medication is appropriate given about a third of those medications are not being prescribed.

BackgroundIn Africa, pharmacovigilance (PV) is a relatively new science. Yet the African context is favourable to the irrational use of medicines, the circulation of counterfeit drugs, and a high consumption of traditional medicine. This should make PV in African countries a critical and crucial issue to ensure the safe use of treatments available. The collection system used in pharmacovigilance in Africa is predominantly passive. This passive system suffers from significant underreporting because it detects only 1–10% of adverse events. The limit in the passive detection and the growing concerns about security in the long term of drugs widely used in health programs, have stimulated in many countries the implementation of active systems such as actively seeking to improve the development of PV in their countries. In Côte d'Ivoire, pharmacovigilance at the regulatory level started in 1988. What is actually the state of pharmacovigilance and the impact of active research in the development of pharmacovigilance?MethodsThis is an observational descriptive study using a qualitative analysis of interviews in order to provide answers to these questions. The interview guides are constructed from a questionnaire already used in the monitoring of pharmacovigilance activities by the Uppsala Monitoring Center in countries with limited resources.ResultsActive surveillance has several sources. A well-known source is the pharmaceutical industry in the conduct of clinical trials and the risk management plans. The pharmaceutical industry accounts for over 80% of reports of adverse effects at national level. The second data source are research centres, but the reporting of adverse effects is not made at national level. The last source of data comes from active operational research studies which as a source are weak and this should be strengthened.ConclusionsActive pharmacovigilance is to be encouraged in Côte d'Ivoire because it will collect data to improve the safety of medicines consumed by the population.