Pattern of drug therapy problems and interventions in ambulatory patients receiving antiretroviral therapy in Nigeria.

  • Bazim V. Ojeh
  • Nasir Naima
  • Isaac O. Abah
  • Kakjing D. Falang
  • Ogwuche Lucy
  • Ibrahim London
  • Christiana Dady
  • Patricia Agaba
  • Oche Agbaji
Keywords: Pharmaceutical Services, Pharmacists, Medication Errors, Anti-HIV Agents, Nigeria


Objectives: We describe the frequency and types of drug therapy problems (DTPs), and interventions carried out to resolve them, among a cohort of HIV- infected patients on ART in Jos, Nigeria.

Methods: A prospective pharmacists’ intervention study was conducted between January and August 2012 at the outpatient HIV clinic of the Jos University Teaching Hospital (JUTH). Pharmacists identified DTPs and made recommendations to resolve them. The main outcome measures were number of DTPs encountered, interventions proposed and acceptance rate of recommendations.

Results: A total of 42,416 prescriptions were dispensed to 9339 patients during the eight months study. A total of 420 interventions (Intervention rate of 1 per 100 prescriptions) were made to resolve DTPs in 401 (4.3%) patients with a mean age of 41 (SD=10) years, and made up of 73% females. DTPs encountered were drug omission (n=89, 21.2%), unnecessary drug (n=55, 13.1%) and wrong drug indication (n=55, 13.1%). Recommendations offered included; Addition of another drug to the therapy (n=87, 20.7%), rectification of incomplete prescriptions (n=85, 20.2%), change of drug or dosage (n=67, 16.0%), and discontinuation of the offending drug (n=59, 14.0%). A total of 389 (93%) out of 420 of the recommendations were accepted. In all, 50.4% (212) of the problematic prescriptions were changed and dispensed, 22.2% (89) were clarified and dispensed, while wrong identities were corrected in 11.7% (49). However, 7.5% (30) prescriptions were dispensed as prescribed, 5.2% (21) were not dispensed, and 3% (12) were unresolved.

Conclusion: Our findings suggest that pharmacists-initiated interventions can ameliorate DTPs in patients receiving ART given the high intervention acceptance rate recorded. The implication of this finding is that pharmacists with requisite training in HIV pharmacotherapy are an excellent resource in detecting and minimizing the effect of antiretroviral drug-related errors.


Download data is not yet available.


1. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: Their structure and function. DICP. 1990;24(11):1093-1097.

2. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management Services. New York, NY: McGraw-Hill; 2012.

3. Adams RE, Boscarino JA. A community survey of medical errors in New York. Int J Qual Health Care. 2004;16(5):353-362.

4. CDC. Injury Prevention & Control: Prescription Drug Overdose. Avalaibale from: (accessed 8 May 2015).

5. ASHP statement on the pharmacist’s role in the care of patients with HIV infection. Am J Health Syst Pharm. 2003;60(19):1998-2003.

6. Li EH, Foisy MM. Antiretroviral and medication errors in hospitalized HIV-positive patients. Ann Pharmacother. 2014;48(8):998-1010.

7. Mok S, Minson Q. Drug-related problems in hospitalized patients with HIV infection. Am J Health Syst Pharm. 2008;65(1):55-59.

8. Heelon M, Skiest D, Tereso G, Meade L, Weeks J, Pekow P, Rothberg MB. Effect of a clinical pharmacist’s interventions on duration of antiretroviral-related errors in hospitalized patients. Am J Health Syst Pharm. 2007;64(19):2064-2068.

9. Rao N, Patel V, Grigoriu A, Kaushik P, Brizuela M. Antiretroviral therapy prescribing in hospitalized HIV clinic patients. HIV Med. 2012;13(6):367-371. doi: 10.1111/j.1468-1293.2011.00977.x

10. Corrigan MA, Atkinson KM, Sha BE, Crank CW. Evaluation of pharmacy-implemented medication reconciliation directed at antiretroviral therapy in hospitalized HIV/AIDS patients. Ann Pharmacother. 2010;44(1):222-223. doi: 10.1345/aph.1M052

11. Agu KA, Oqua D, Adeyanju Z, Isah MA, Adesina A, Ohiaeri SI, Ali PN, Ekechukwu N, Akpakwu AA, Sani T, Omeh IO, King RC, Wutoh AK. the incidence and types of medication errors in patients receiving antiretroviral therapy in resource-constrained settings. PLoS One. 2014;9(1):e87338. doi: 10.1371/journal.pone.0087338

12. Abah IO, Ojeh VB, Falang KD, Darin KM, Olaitan OO, Agbaji OO.Pharmaceutical care outcomes in an outpatient human immunodeficiency virus treatment center in Jos, Nigeria. J Basic Clin Pharm. 2014;5(3):57-61. doi: 10.4103/0976-0105.139727.

13. Abah IO, Nweke N, Omede P, Dangiwa D, Jimoh HO. Outcome of pharmacist intervention on out-patient prescription in a Nigerian tertiary health facility. High Med Res J. 2013;13:49-52.

14. Abah IO, Ojeh VB, Musa J, Ugoagwu P, Agaba PA, Agbaji O, Okonkwo P. Clinical utility of pharmacy-based adherence measurement in predicting virologic outcomes in an adult HIV-infected cohort in Jos, North Central Nigeria. J Int Assoc Provid AIDS Care. 2014[ahead of print]

15. Weekly summary form: pharmacist and patient intervention documentation. Available at (accessed 12 December 2011).

16. Chiampas TD, Kim H, Badowski M. Evaluation of the occurrence and type of antiretroviral and opportunistic infection medication errors within the inpatient setting. Pharm Pract (Granada). 2015;13(1):512.

17. Al Rahbi H, Al-Sabri RM, Chitme HR. Interventions by pharmacists in out-patient pharmaceutical care. Saudi Pharm J. 2014;22(2):101-106. doi: 10.1016/j.jsps.2013.04.001

18. Boardman H, Fitzpatrick R.Self-reported clinical pharmacist interventions underestimate their input to patient care. Pharm World Sci. 2001;23(2):55-59.

19. Pottegård A, Hallas J, Søndergaard J.Pharmaceutical interventions on prescription problems in a Danish pharmacy setting. Int J Clin Pharm. 2011;33(6):1019-1027. doi: 10.1007/s11096-011-9580-4

20. WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach, June 2013. Available from: (accessed 6 May 2015).

21. Bradley CP, Taylor RJ, Blenkinsopp A. Primary care - Opportunities and threats: Developing prescribing in primary care. BMJ. 1997;314(7082):744-747.

22. Struck P, Kristine HP, Moodley P, Rasmussen M. A pilot study of pharmacist-initiated interventions in drug therapy in an Australian pediatrics hospital. EJHP Sci ed. 2007;13:105-112.

23. Dooley MJ, Allen KM, Doecke JC, Galbraith JK, Tailor GR, Bright J. A prospective multi-centre study of pharmacist initiated changes to drug therapy and patient management in acute care government funded hospitals. Br J Clin Pharmacol. 2004;57(4):513-521.

24. Saberi P, Dong BJ, Johnson MO, Greenblatt RM, Cocohoba JM. The impact of HIV clinical pharmacists on HIV treatment outcomes: A systematic review. Patient Prefer Adherence. 2012;6:297-322. doi: 10.2147/PPA.S30244
Original Research