Access to anti-hypertensive and anti-diabetic medications amongst people living with HIV in Soroti District, Eastern Uganda

Abstract

Background: Access to anti-diabetic and anti-hypertensive medicines is one of the factors that needs to be addressed so as to ensure continuous availability of affordable quality of care to HIV clients living with hypertension and diabetes. Inability to bridge the gap of anti-hypertensive and anti-diabetic medicine access will offset the tremendous gains associated with the use of antiretroviral therapy.

Objective: To determine access to anti-hypertensive and anti-diabetic medicines amongst HIV clients.

Methods: This was a cross-sectional study that collected both qualitative and quantitative data. A semi-structured questionnaire was used to collect quantitative data from 215 HIV positive hypertension and diabetic clients. The collected data was entered into SPSS version 24, and analyzed using descriptive statistics and logistic regression to assess access to anti-hypertensive and anti-diabetic medicines. An interview guide was used to collect qualitative data from 16 key-informants (pharmacist, prescribing clinicians, dispensers, stores attendants and nurse in-charges). Collected data was transcribed, exported into Atlas.ti 22 software, and analyzed thematically.

Results: The six anti-hypertensive and anti-diabetic medicines observed were stocked-out for an average of 26.02% (16/60 days) of the days. The anti-hypertensive medicines had more stock-out days (20/60 days) compared to anti-diabetic medicines which had a stock-out duration of (12/60) days. Losartan-hydrochlorothiazide, anti-hypertensive medicine had the highest number of stock-out days (32/60) days. Accessibility was poor, with the majority 193 (89.8%) of the clients travelling more than 5Km for their medicine refills and only 86 (40%) of the clients receiving all their prescribed medicines. Medicine affordability was also poor, with majority 183 (85.1%) of the clients at risk of catastrophic health expenditure. Education level (AOR=0.245; 95% CI: 0.092-0.655; p=0.005˂0.05) was significantly associated with accessibility to non-communicable disease medicines. Supply chain practices affecting access to anti-hypertensive and anti-diabetic medicines included; inadequate technical personnel, and limited funds.

Conclusion: Access to non-communicable disease medicines is generally poor as illustrated by poor accessibility, affordability, persistent stock-outs, limited funds, inadequate technical personnel, and delayed delivery of medicines by the central medical store.

Recommendation: Government needs to strengthen health facilities in the management of non-communicable diseases by increasing access to medicines.

Key words: Access, availability, accessibility, affordability, HIV/AIDS, NCDs, HIV and NCDs.