Antiretroviral medication prescription errors and associated factors among HIV infected children in selected health facilities in Nairobi, Kenya

BACKGROUND

Access to life saving antiretroviral therapy (ART) in many resource-limited settings has increased, yet more than 30% of children on ART do not achieve viral suppression. Multiple factors contribute to viral suppression including patient, drug and health system factors. Infants and children require continuous medication dose adjustments in response to changing pharmacodynamics and inappropriate dosing may contribute to viral non-suppression. This study sought to determine the magnitude of prescription dosing errors and associated factors.

METHODS

We conducted a cross sectional study among HIV Infected children aged ≤11 years receiving ART in four public health facilities. Demographic, clinical and prescription data were abstracted from the medical charts of children receiving ART for the last clinical visit. Descriptive statistics were used to summarize participant characteristics. Logistic regression was conducted to determine factors associated with prescription dosing errors. Results: A total of 196 children were included in the study; among these, 52.6% were male and the median age was 7.9 years (IQR 4.8, 10.0). The most commonly used ART regimen was abacavir/lamivudine/lopinavir/ritonavir taken by 31.1% (61/196) of children. Overall, 43.6% (85/196), 45.9% (90/196) and 46.9% (92/196) of children lacked data on specific ARV formulation, dosage and frequency of dosing, respectively. Among 104 children with complete prescription information, the dosing error rate was 36.5% (38/104). In a multivariable model, being on non-nucleoside reverse transcriptase inhibitors was independently associated with prescription dosing errors (adjusted odds ratio 8.8; 95% confidence interval 2.1-36.3).

CONCLUSION

Half of children receiving antiretroviral therapy had inadequate prescription information and among those with adequate information, one third had prescription dosing errors. These findings calls for urgent measures to address health care prescribing practices and knowledge. In addition, further evaluation should be conducted to determine associations with viral suppression.