Assessment of community pharmacies readiness to dispense antiretroviral medicines in Rwanda

ABSTRACT

Background:

Since the introduction of the ‘Test and treat’ approach in the Human Immunodeficiency Virus (HIV) management, various strategies have been devised and implemented by countries to relieve public health facilities of the large numbers of people coming for medicine refills and clinical follow-up. One of the strategies is the dispensing of antiretroviral medicines through community pharmacies. In Rwanda, community pharmacies are not yet involved in antiretrovirals (ARVs) dispensing, and no study has assessed their readiness to provide this service. This study aimed to assess the readiness of community pharmacy staff and infrastructure to implement a decentralised model of antiretroviral medicines dispensing.

Methods:

This cross-sectional study included data from 262 community pharmacies sampled across all districts of Rwanda. Primary data were collected using a structured questionnaire, from February to March 2023. Responses were received for 262 community pharmacies, representing the total sample size. Data analysis was done using quantitative descriptive and inferential statistical approaches. Frequency tables and graphs were produced using STATA15 and the outputs were exported to MS Excel as well as MS Word to allow document framing and designing.

Results:

The research has shown a high proportion of community pharmacy staff trained in HIV prevention (82.4% trained on HIV testing), but a low level of training in treatment (30.5%) and psychosocial support of people living with HIV (29.8%). Infrastructure and storage conditions were found to be adequate, with 99.6% of surveyed Pharmacies having sufficient storage space. Majority (93.9%) expressed their willingness to dispense ARVs in the pharmacy premises. A large number of respondents (92.4%) felt that dispensing of antiretroviral medicines through community pharmacies would lead to an increase in sales of over the counter and other non-HIV related medicines. The main anticipated challenge that should be addressed to ensure effective implementation is the lack of interoperability between reporting systems used by community pharmacies and those used by health facilities providing HIV services (76.7% of respondents).

Conclusion:

Community pharmacies in Rwanda have majority of staff trained in various areas of HIV prevention, but a small proportion have been trained in HIV care and treatment. Community pharmacies have the necessary infrastructure to dispense ARVs, and those with shortcomings, such as the lack of a separate room for individual patient counselling, are willing to obtain such a room if they are authorised to dispense ARVs. Staffs are willing to dispense ARVs in community pharmacies if the model is recommended by policymakers. The model could have several benefits for community pharmacies and the public health system in general, but there are also challenges that should be mitigated to ensure effective implementation. The staff willingness and expected benefits constitute enabling factors that the Ministry of Health and the national HIV control programme may leverage to prepare for introducing the model of ARVs distribution through community pharmacies.

KEYWORDS:

• HIV
• AIDS
• antiretroviral medicines
• dispensing
• community pharmacies
• readiness

Acknowledgements

The authors of this paper gratefully acknowledge the funding of the Master of Health Supply Chain Management by the German Federal Ministry for Economic Cooperation and Development (BMZ) through KfW Development Bank and the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management. In addition, this research would not have been possible without the assistance of the College of Medicine and Health Sciences, University of Rwanda. Authors’ contribution. CM contributed to the conception, methodology, data collection and their analysis, writing of the original draft and reviewed the final manuscript. JBN and IH contributed to conception of the study and reviewed the manuscript. All authors gave final approval to the version to be published, agreed on the journal to which the article had been submitted, and agreed to be accountable for all aspects of the work.

Ethics approval and consent to participate

The ethical approval for this study was obtained from the College of Medicine and Health Sciences of the University of Rwanda through its Institutional Review Board (Reference number: CMHS/IRB/028/2023). Nobody was influenced to participate in the study. A conversation was used to inform the community pharmacy staff of the purpose of the study and the information required from them. Any questions potential participants had about the study were answered, and only staff who gave oral consent to participate were considered for the study. No signed consent was used for this research.

Consent for publication

Not applicable.

Availability of data and materials

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors do not have any conflict of interest; they have no affiliations with or involvement in any organisation or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

Additional information

Funding

This study received financial support from German Federal Ministry for Economic Cooperation and Development (BMZ) through KfW Development Bank and the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management.

Notes on contributors

Cyprien Musafiri

Cyprien Musafiri is a Pharmacist with sound experience in public health commodities supply chain management. He holds a Master's degree in Pharmaceutical Sciences/Quality Assurance and Quality Control and a Master's degree in Health Supply Chain Management, both from the University of Rwanda. Cyprien Musafiri has served in a variety of positions that have enabled him to acquire solid experience in health products sourcing, warehousing, inventory management, distribution, promoting rational medicine use, safety monitoring, managing human and financial resources for health, supply chain workforce capacity development and overall system optimization. He has received various training and certifications, including the certification in humanitarian medical logistics practices and the management of medicines in international health. Cyprien Musafiri has held various positions in Rwanda including Director of District Pharmacy, Senior Officer for HIV Commodities Management and Specialist in charge of Pharmaceutical Development and Supply Chain Coordination at the Ministry of Health. He currently works as Health Products Management Specialist for the Global Fund to fight AIDS, Tuberculosis and Malaria.

Jean Baptiste Nyandwi

Dr. Jean Baptiste Nyandwi holds a BPharm degree from National University of Rwanda, a Master's degree in Pharmaceutical Sciences, Quality Control and Quality Assurance from University of Rwanda (Rwanda) in collaboration with University of Liege (Belgium), and a PhD in Science (Convergence Medical Science) from Gyeongsang National University, South Korea in the area of Molecular Pharmacology. Dr. Nyandwi is a Lecturer and Researcher in Pharmacy Department for a decade and former head of Pharmacy Department at the University of Rwanda. He also serves as the Training Coordinator at the EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management (RCE-VIHSCM). He oversees and coordinates capacity building and talent development in the area of vaccines manufacturing, vaccinology, regulatory affairs and supply chain management at the EAC RCE-VIHSCM. Dr. Nyandwi is a member of National Pharmacovigilance Advisory Committee of Rwanda Food and Drugs Authority since 2021 and seats as member of Technical Committee (TC) on Pharmaceutical Products of Rwanda Standards Board (RSB/TC 015) since 2018. He is also a member of Regulatory Capacity Development Sub Technical Committee (RCD- Sub TC) on Vaccines Regulatory Oversight of AUDA-NEPAD. Dr. Nyandwi is a Pharmacist by profession and registered as a Senior Consultant Pharmacist in Rwanda. He has expertise in developing and implementing academic programmes. He has authored a number of peer reviewed papers in peer-reviewed international journals in pharmacology and pharmacy sphere and serves as a reviewer of different peer reviewed Journals.

Innocent Hahirwa

Dr Innocent Hahirwa is a Senior Lecturer and a Senior Consultant Pharmacist with a Ph.D in Biomedical and Pharmaceutical Sciences/Clinical Toxicology from University of Liege (Belgium). Technically, he has an extensive experience in teaching, research, administration and clinics. In addition to the formal academic training, Dr Hahirwa has been trained in different areas of Pharmacy profession including, Pharmacy profession regulation, Drug registration, Pharmacovigilance, Pharmaceutical products (including hazardous products) handling and Clinical Trials. Dr HAHIRWA is teaching different courses related to Toxicology, Pharmacology, Pharmacovigilance and Clinical trials at both Undergraduate and Postgraduate levels, and has supervised a number of research works for UG and PG students. He is also in charge of clinical pharmacy care and training in Kigali University Teaching Hospital. His research areas of interest include mainly Toxicology, Pharmacology, Clinical Biology as well as Pharmacy practice and regulation. Having occupied different managerial positions including being the Chairperson and a member of the National Pharmacy Council Board, Head of Pharmacy Department and Deputy Dean of the School of Medicine and Pharmacy at the University of Rwanda for several years, Dr HAHIRWA has strong leadership and management skills.