Background: In 2007, Zambia's national Antiretroviral Therapy (ART) program revised the treatment protocols that were introduced in 2004, to more efficacious first line regimens with reduced toxicities and better resistance mutation profiles, thereby preserving drug options for second line treatment. The change in protocols introduced tenofovir as the preferred first line nucleotide reverse transcriptase inhibitor (NRTI) and Abacavir as the alternative NRTI for patients initiating treatment. It moved stavudine and zidovudine to second line, with phased out recommendation of stavudine 40 mg BID.
Methodology: A review of the program data collected from all 19 AIDSRelief (AR) sites using a regimen data abstraction sheet provided by the national ART program was done from January 1, 2008 to March 31, 2011.
Results: Of the 13,584 adult patients on ART at the end of 2007 and within 6 months of introduction of the new standard treatment protocols, 22.5% of all adult patients on therapy received the new recommended treatment protocol for first line therapy. Of these, almost all (99.3%) received the preferred first NRTI drug. By the end of December 2008, 13,603 patients were newly enrolled onto ART, and of these, 29.2% was according to the national protocol. Currently 74% of patients enrolled onto first line ART in AR sites receive the recommend national treatment regimens. The program successfully phased out stavudine 40 mg BID by early 2009.
Discussion: Implementation of new treatment protocols in AR sites is ongoing and a lag of more than three years is evident. Future research is needed to determine effective dissemination and implementation of new recommendations at facility level, to ensure the best treatment options are available as soon as possible and to evaluate the impact of the implementation delay on patient level outcomes, and national ART drug funding and procurement policies.
(C) 2012 Lippincott Williams & Wilkins, Inc.