Evaluation of Antiretroviral-Related Problems and Interventions by the Clinical Pharmacist in Hospitalized HIV-Infected Patients At Omdurman Management And clinical unit of HIV/AIDS Center (OMACU) Sudan, Khartoum, Omdurman

The aim of the study was to identify antiretroviral-related problems in the prescribing of medication to Sudanese HIV-infected inpatients and to determine the degree of acceptance of the pharmacist's interventions. This study was carried out at Omdurman Teaching Hospital (OTH) by a clinical pharmacist trained in HIV pharmacotherapy for one year prospectively. The interaction of antiretroviral was checked for contraindicate combination. Inpatient antiretroviral prescriptions were compared with outpatient (hospital records) dispensing records for reconciliation. Renal and hepatic functions were monitored to check dose adjustments whenever it is needed. The prescriptions for 100 admissions (80 patients) were reviewed. Thirty antiretroviral-related problems were identified in 40 patients (50%). The most common problem was contraindicated combinations (n=10; 33.33%), followed by incorrect dose (n=5;16.7%), dose omission (n=4;13.3%), lack of dosage reduction in patients with renal or hepatic impairment  (n=4;13.3%) ,omission of an antiretroviral (n=3; 10%), incorrect schedule according to outpatient treatment (n=2 ;6.7%),prescriptionofalternativeantiretroviraldrugs(n=2;6.7%).Fifteen out of 20 errors were made during admission. A multivariate analysis, the factors associated with an increased risk of HAART-related problems ,were renal impairment OR 4; 95% confidence interval (CI) 1.400 to 11.320, treatment with lopinovir (OR 3.75; 95% CI 0.0198 to 50.44) and admission to a unit other than an infectious diseases unit (OR2.515; 95% CI 0.0300 to 5.00). Prescription1.5 to7.558 of a nonnucleoside reverse transcriptase inhibitor was a protective factor (OR 0.30; 95% CI 0.1339 to 0.850). Ninety per cent of the pharmacist's interventions were accepted. Antiretroviral-related errors affected more than one-in-three patients. The most common causes of error were contraindicated or not recommended drug–drug combinations and dose-related errors. A well-trained clinical pharmacist would help to detect medication problems and promote for antiretroviral drugs use rationally