Underreporting of side effects of standard first-line ART in the routine setting in Blantyre, Malawi.|
Tapsfield, Julia; Mathews, Teena; Lungu, Molly & van Oosterhout, Joep J.
In the Malawi ART programme, 92% of 250,000 patients are using the
standard first-line regime of stavudine-lamivudine-nevaripine. National
ART reports indicate <4% experience ART side effects, much less than
expected from literature.
We interviewed adult patients on standard first-line ART for at least
one year, after routine visits to an urban clinic in Blantyre, Malawi. We
determined the prevalence of symptoms that are common side-effects,
described discrepancies between symptoms that patients reported to us
and those that had been recorded by attending staff as side-effects in the
point-of-care electronic monitoring system, and studied factors associated
with such discrepancies.
Of 170 participants, 75 (44%) reported at least one symptom, most
common were symptoms suggesting peripheral neuropathy (n=57) and
lipodystrophy (n=16). Forty-six (66%) symptomatic patients said they
reported symptoms to attending ART staff. Side-effects were recorded
in the clinic database for just 4 patients. Toxicity recording was too low
for meaningful analysis of factors associated with discrepancies between
reporting and recording of side-effects. The prevalence of symptoms
indicating characteristic side-effects of the standard first-line regimen was
39% based on interviews, and 2% in the electronic monitoring system.
There was gross under-recording of side-effects in this setting, mainly
due to not recording by ART staff. Pressure of work and insufficient
perceived benefit of side-effect recording are suspected causes. Local and
national ART reports do not reflect the true toxicity of the standard firstline