Mobile ARV Pharmacy at TREAT Sites in Rural Uganda

Principal Investigator: Ajay Sethi

In Uganda, the Joint Clinical Research Center (JCRC) has built a network of HIV clinics with the capacity to deliver antiretroviral therapy (ARV) safely and effectively through its TREAT program (Timetable for Regional Expansion of Antiretroviral Therapy). In rural areas, patients tend to live far from the clinic and distance is a barrier to picking up HIV medication refills on time. The result is unintended non-adherence to ARVs and the potential for patients to develop resistance to ARVs. To address this problem, we will integrate a mobile ARV pharmacy into HIV care at three rural TREAT sites. After identifying patients who would benefit from receiving ARVs via this strategy, we will synchronize their monthly refill dates so that we can operate the mobile pharmacy on as few days as possible and minimize costs. We will implement the strategy, determine its feasibility, and estimate its effectiveness in improving adherence. We will recruit 700 patients at three hospitals to formally evaluate the mobile ARV pharmacy. We believe that the mobile pharmacy will improve adherence to ARVs and HIV care and decrease the occurrence of treatment failure. We will also determine whether the intervention decreases overcrowding at the clinic and patient wait time and increases doctor-patient time. If the intervention is satisfying to patients and physicians, effective in improving ARV adherence, and affordable, we will recommend use of this strategy country-wide and possibly in other rural settings where distance is a barrier for HIV-infected patients.