Tsitsi Pendula

Fellowship Site: University Of Zimbabwe

Project Title: Implementing and evaluating an electronic herbal medicine reconciliation tool towards safe integration among HIV infected people (CHeMU_i.e.)

The goal of my research is safe integration of conventional and herbal medicine. While people living with HIV appreciate the effectiveness of antiretroviral therapy, they still choose to use herbal medicines for various reasons. However, their clinicians are often unable to guide them because of the limited clinical evidence base. This exposes patients to adverse events such as hypersensitivity reactions, toxicity and herb-drug interactions which may lead to poor adherence, treatment failure and drug resistance. Medication reconciliation lists that do not incorporate herbal medicines may also inadvertently overlook related adverse events, particularly in HIV clinics were herbal medicine use is high. Previous work showed that medication reconciliation tools and processes employed at HIV clinics in Zimbabwe are not targeted enough to document herbal medicine use in a useful way. However, clinicians considered herbal medicine reconciliation important and were willing to probe and document use provided a concise tool was made available. This proposal will therefore implement electronic herbal medication reconciliation into HIV clinical practice and evaluate its utility and acceptability among HIV clinicians. An electronic herbal medicine use data capturing tool will encourage communication and standardised documentation of herbal medicine use by HIV care providers. To achieve this, a paper-based herbal medicine data capture tool developed with input from clinicians and current literature recommendations, will be used to augment electronic medication history taking tools currently in use at selected HIV clinics. Clinicians at the sites will be trained on how to use the tool and asked to incorporate it into daily practice. Consenting clinicians involved with medicine history-taking will be invited to participate in focus group discussions to evaluate their experiences. The database will also be reviewed to determine any change in the rate of herbal medicine use capture after implementation of the tool. The vision is to establish an electronic herbal medicine use database that will serve as a source of information. This database will help to rapidly identify herbal medicines that should be prioritised for further clinical assessments such as potential herb-antiretroviral drug interactions, effect on liver and kidney function, as well as impact on HIV treatment outcomes.