Perspective of healthcare workers in Nigeria on the introduction of new pediatric antiretroviral drugs: experiences, enablers and barriers

Title

Perspective of healthcare workers in Nigeria on the introduction of new pediatric antiretroviral drugs: experiences, enablers and barriers

Presenter

Oluwakemi Sowale

Authors

O. Sowale * (1), W. Eigege (1), O. Abudiore (1), B. Levy-Braide (1), N. Otubu (1), A. Inyang (1), J. Campbell (2), D. Rathakrishnan (3), I. Amamilo (1), F. Lufadeju (1), C. Amole (4), O. Wiwa (5), C. Adesigbin (6), E. Etiobhio (6), A. Ikpeazu (6), O. Agbaji (7), S. Akanmu (8), U. Lawal (9), S. Ochigbo (10), J. Conroy (4)

Institutions

(1) Clinton Health Access Initiative, HIV Access Program, Abuja, Nigeria, (2) Clinton Health Access Initiative, Research & Labs - Applied Analyics, Boston, United States, (3) Clinton Health Access Initiative, HIV Access Program, Kigali, Rwanda, (4) Clinton Health Access Initiative, HIV Access Program, Boston, United States, (5) Clinton Health Access Initiative, Global Resource for Health, Abuja, Nigeria, (6) Federal Ministry of Health, National AIDS and STI Control Program, Abuja, Nigeria, (7) Jos University Teaching Hospital, Jos, Nigeria, (8) Lagos University Teaching Hospital, Lagos, Nigeria, (9) Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, (10) University of Calabar Teaching Hospital, Calabar, Nigeria

BACKGROUND: Nigeria recently introduced pediatric dolutegravir (pDTG) based regimen as the preferred first-line antiretroviral therapy (ART) among children <20kg. Prior to this introduction, the country has implemented over 3 regimen transitions within the last decade, the most recent being transition to lopinavir/ritonavir-based regimen. With the imminent transition to pDTG based regimen, feedback from healthcare workers (HCW) on their experiences, enablers, and barriers to introducing new antiretrovirals (ARVs) to patients is important to guide ART transition in-country.
METHODS: In June 2021, focus group discussions (FGDs) were conducted among HCWs as part of an operations research on pDTG in 7 ART facilities across 7 states (Akwa Ibom, Benue, Cross River, Lagos, Plateau, Rivers and Sokoto). Participants included clinicians, pharmacists, nurses, and adherence counsellors directly involved in prescribing/dispensing ARVs to patients. The FGDs were facilitated using a guide designed to elicit responses on barriers/enablers to prescribing new pediatric ARVs. Discussions were recorded, transcribed, and a codebook developed on MS Excel. This was then analyzed by 2 independent reviewers to assess for major themes.
RESULTS: 31 HCWs participated in 7 FGDs (4 ' 7 participants per FGD).64% of respondents noted that bitter taste will discourage them from prescribing new drugs, while 45%, 36% and 14% respectively stated difficulty with administration, high pill burden and frequent dosing as barriers. Other limitations to prescription of new ARVs and the proportion of respondents that indicated them are frequent introduction of new ARVs in-country (63%) and concerns on sustained availability (25%), misconceptions (21%) and initial fears among patients about side effects (14%).
65% of respondents indicated that availability of scientific evidence on superiority of the new drug is a key enabler for prescription, while 60% and 38% respectively sweet taste and capacity building for HCWs on the new drug as enablers. The participants considered pDTG as an improvement on the current pediatric ARV in terms of taste, frequency of dosing, ease of administration.
CONCLUSIONS: Findings from the FGDs provided insight into the perspective of HCWs on the introduction of new pediatric ARVs. This will inform scale-up plans for transitioning clients to pDTG and increase preparedness for future ARV transitions.

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