Determining quantities to be dispensed and next appointment

Clinical description

appointment

• Table 19 on page 75 shows the number of tablets to be supplied for appointment intervals of 4, 8,

12 or 24 weeks for the total number of tablets taken of each ARV per day (paediatric and adult formulations).

o Use Table 17 to add up the ‘total tablets taken per day’ for each ARV contained in the regimen. For example: a child of 10kg on ABC/3TC + DTG (Regimen 15PP) takes 2 paediatric tablets of ABC/3TC and 2 paediatric tablets of DTG in the morning.

o Note: regimens that are given in 2 or more different tins may not be used up at the same time. For example, children on 15PP will finish ABC/3TC long before DTG because DTG is supplied in 90 tabs tins. Make sure the patient / guardian comes back for a refill before running out of either ARV to avoid that only part of the regimen is taken.

o The Actual number of tablets needed is the minimum number of total tablets the patient needs to take home to cover the time to the next appointment. (Total tablets = tablets remaining from the previous visit + tablets newly dispensed). The number needed includes an extra 2-day supply to act as a safety-buffer. The total tablets must meet or exceed the Actual number of tablets needed.

o Different ARVs come in tins of 30, 60, 90 or 120 tablets (see Table 17). Given that only full tins should be dispensed, the number of tablets needed is rounded up to multiples of full tins.

o Rounding up may result in a considerable over-supply. For some regimens and dosages, perfectly adherent patients will be left with more than half a tin of ARVs at their next appointment. Explain this to the patient / guardian and emphasize the importance of keeping the next appointment and always making sure they have all drugs not just some (15PP in particular).

o The number of tablets expected to be used in the interval is shown for ‘perfect adherence’ (100%) and for ‘good adherence’ (95%-105%).

o Calculate the number of tablets used by subtracting total tablets remaining at the current visit from total tablets available at the end of the previous visit.