A Pharmacy-only Refill Programme (PRP) a type of task shifting in which stable HIV-positive patients are managed through pharmacy-only visits instead of physician visits. We performed a study to identify factors for being removed from the PRP in order to establish better referral criteria. The study was performed at the Infectious Disease Clinic (IDC) in Kampala, Uganda. We selected a random sample of 588 patients from 2431 patients on antiretroviral therapy referred to the PRP at least 12 months before commencement of the PRP evaluation. We compared the characteristics of patients who during 12 months of follow-up were removed from the PRP with those who continued to be followed up. Data were abstracted from the IDC data base, the pharmacy register and the patient clinical notes. Of 588 patients, 106 (18%) were removed from the PRP. In multivariate analysis, less than 100% self-reported adherence to antiretroviral therapy, missing at least one scheduled appointment in the six months before referral to the PRP and being on a lopinavir/ritonavir-containing regimen were independently associated with being removed from the PRP. Criteria for referring patients to a PRP should focus on antiretroviral therapy adherence and appointment keeping. Patients on a lopinavir/ritonavir-containing regimen should not be targeted for a PRP. On the other hand a PRP is an efficient strategy that targets stable adherent patients in clinics with high patient load.

ObjectivesWhile highly active antiretroviral therapy (HAART) decreases long-term morbidity and mortality, its short-term effect on hospitalization rates is unknown. The primary objective of this study was to determine hospitalization rates over time in the year after HAART initiation for virological responders and nonresponders. MethodsHospitalizations among 1327 HAART-naïve subjects in an urban HIV clinic in 1997-2007 were examined before and after HAART initiation. Hospitalization rates were stratified by virological responders ( ! 1 log 10 decrease in HIV-1 RNA within 6 months after HAART initiation) and nonresponders. Causes were determined through International Classification of Diseases, 9th Revision (ICD-9) codes and chart review. Multivariate negative binomial regression was used to assess factors associated with hospitalization. ResultsDuring the first 45 days after HAART initiation, the hospitalization rate of responders was similar to their pre-HAART baseline rate [75.1 vs. 78.8/100 person-years (PY)] and to the hospitalization rate of nonresponders during the first 45 days (79.4/100 PY). The hospitalization rate of responders fell significantly between 45 and 90 days after HAART initiation and reached a plateau at approximately 45/100 PY from 91 to 365 days after HAART initiation. Significant decreases were seen in hospitalizations for opportunistic and nonopportunistic infections. ConclusionsThe first substantial clinical benefit from HAART may be realized by 90 days after HAART initiation; providers should keep close vigilance at least until this time.Keywords: AIDS-defining illness, antiretroviral therapy, healthcare utilization, hospitalization, immune reconstitution Accepted 7 August 2009 IntroductionIn the short term after starting highly active antiretroviral therapy (HAART), HIV-infected patients may have an increased risk of serious illness as a result of an immune reconstitution inflammatory syndrome (IRIS), a traditional opportunistic infection (OI), or an adverse drug reaction. While HAART is known to decrease hospitalization rates and mortality in the long term [1][2][3][4][5][6][7], the time at which hospitalization risk declines during the weeks to months immediately following HAART initiation is not clear.In studies in high-income countries conducted since the advent of HAART in 1996, AIDS-defining illnesses (ADIs) and non-ADI infections have been the most frequent reasons for hospital admission [1,4,6,[8][9][10][11]. The next most common categories of admitting diagnoses have varied among mental illness, gastrointestinal and hepatic disease, and cardiovascular disease. Studies have compared hospitalization rates for these disease categories in the several years prior to the advent of HAART vs. the several years after its advent among cohorts of patients, not all of whom were prescribed HAART [1,4,5,[12][13][14][15][16][17]. These studies did not determine changes in an individual's risk of serious illness within these disease categories in the weeks to months immediately after initia...