Prescription of Levofloxacin and Moxifloxacin in Select Hospitals in Uganda : A Pilot Study to Assess Guideline Concordance

Background : In Uganda, national tuberculosis (TB) treatment guidelines were revised to include the newer generation fluoroquinolones among the second-line treatment options for multidrug-resistant TB. This study was designed to analyze if the prescription of these quinolones is compliant with country recommendations. Methods : This was an observational retrospective study of consumption data for 2017 and 2018 across four selected regional referral hospitals. The sources of consumption data were hospital pharmacy stock cards and the dispensing register. The medical files of patients who had been prescribed fluoroquinolones were also assessed to study compliance with the Uganda Clinical Guidelines and the British National Formulary (BNF). Results : None of the 371 levofloxacin prescriptions analyzed complied with the Uganda Clinical Guidelines, although 250 (67.3%) were prescribed for indications included in the BNF. According to WHO prescription indicators, only 220 (59.3%) prescriptions were appropriate. Conclusion : The prescription of levofloxacin and moxifloxacin increased in the hospitals studied, but in a high proportion of cases, they were not compliant with country recommendations. The findings call for the strengthening of national antimicrobial stewardship programs

Facilitators and Barriers to Uptake of the Med Safety Mobile App for Adverse Drug Reaction Reporting by Health Workers in Uganda: A Qualitative Study

IntroductionAdverse drug reactions (ADRs) are an important public health challenge worldwide; however, pharmacovigilance systems are plagued by under-reporting. Mobile technologies, including mobile applications such as Med Safety, could strengthen ADR reporting. We explored the acceptability, and factors that could influence uptake of, Med Safety for ADR reporting by health workers in Uganda.MethodsThe study took place between July and September 2020 in 12 HIV clinics in Uganda and employed a qualitative exploratory research design. We conducted 22 in-depth interviews and 3 mixed-gender focus group discussions (49 participants) with a diverse range of health workers. We analysed the data using a thematic approach.ResultsThere was goodwill among the health workers to adopt Med Safety for ADR reporting and the majority would recommend the app to other health workers. Training with practice increased acceptability of the app. Uptake of the app was favoured by the younger, technology proficient, health worker demographic; the app's offline and two-way risk communication functionalities; availability of free internet hotspots at some health facilities; goodwill and willingness of health workers to report ADRs; and the cumbersome nature of conventional ADR reporting tools. Potential barriers to the uptake of Med Safety were the perceived lengthy processes of initial app registration and completion of multiple screens during ADR reporting; challenges with health workers' smartphones (incompatibility with application, no space for more applications, low battery charge); high cost of internet data; poor internet connectivity; difficulty in recognising ADRs, language barrier and poor feedback to ADR reporters.ConclusionThere was goodwill among the health workers to adopt Med Safety for ADR reporting and the majority would recommend the app to other health workers. Training with practice increased acceptability of the app and should be integral in all future app roll-out campaigns. The identified facilitators and barriers could be used to appropriately guide future research and implementation to promote the uptake of Med Safety for pharmacovigilance in low- and middle-income countries

Personal and professional factors associated with comprehensive ADR description of most recent past-month suspected ADR for 241 healthcare professionals who suspected ADR(s) in the previous month and provided a description, Uganda, 2013.

<p>* Covariates not fitted into the final logistic regression model.</p><p>Personal and professional factors associated with comprehensive ADR description of most recent past-month suspected ADR for 241 healthcare professionals who suspected ADR(s) in the previous month and provided a description, Uganda, 2013.</p

Survey-descriptions of 51 rare suspected Adverse Drug Reactions (ADRs) of Healthcare Professionals (HCPs) who suspected ADRs in the past 4 weeks.

<p><b>KEY:</b> ADR = ADVERSE DRUG REACTION; ART = ANTIRETROVIRAL THERAPY; AZT = ZIDOVUDINE; BNF = BRITISH NATIONAL FORMULARY; EFV = EFAVIRENZ; FLAGYL = METRONIDAZOLE; HAART = HIGHLY ACTIVE ANTIRETROVIRAL THERAPY; ISS = IMMUNOSUPRESSED SYNDROME; IV = INTRAVENOUS; MEPHAQUINE = MEFLOQUINE; NVP = NEVIRAPINE; SEPTRIN = COTRIMOXAZOLE; SJS = STEVENS-JOHNSON SYNDROME; TDF = TENOFOVIR; 3TC = LAMIVUDINE;</p><p>* = CHECK APPENDIX S4 FOR TWO OR MORE DESCRIBED ADVERSE DRUG REACTIONS; PHARM = PHARMACIST/PHARMACY TECHNICIAN.</p><p>Survey-descriptions of 51 rare suspected Adverse Drug Reactions (ADRs) of Healthcare Professionals (HCPs) who suspected ADRs in the past 4 weeks.</p

Survey-description of the most recent past-month suspected ADR provided by 241 out of 268 HCPs who suspected ADRs in the previous month, Uganda, 2013.

<p>*Route of administration could be inferred for a further 63 (6 were by injection & 59 were oral) ADR descriptions.</p><p>Survey-description of the most recent past-month suspected ADR provided by 241 out of 268 HCPs who suspected ADRs in the previous month, Uganda, 2013.</p