A quality improvement intervention to reduce inappropriate prescribing of antibiotics using a combined behavioural bundle in an urban HIV care outpatient setting in Uganda
1
Research, Infectious Diseases Institute, Kampala, Uganda
Popul. Med. 2026;8(Supplement Supplement 1):A225
ABSTRACT
BACKGROUND:
Inappropriate prescribing is a major contributor to Antimicrobial Resistance (AMR). A study conducted in an adult HIV clinic found inappropriate prescribing rates of 88%1. The alarming rates underscore the urgent need to address antibiotic misuse, further emphasising the importance of AMS (Antimicrobial Stewardship) to ensure antibiotics remain effective and are used judiciously.
OBJECTIVE:
To implement and evaluate the impact of a combined AMS intervention to reduce antibiotic prescribing rates in an adult HIV clinic from 82% to 50%
METHODS:
This quality improvement project was conducted in an adult HIV clinic through three phases: pre-implementation, implementation, and post-implementation. The intervention was informed by the Behaviour Change Wheel2 and used its intervention functions to guide the design of a multifaceted AMS bundle. Components included clinician education sessions, dissemination of updated outpatient prescribing guidelines, digital and printed AMR awareness materials for clinicians and patients, structured patient education, an antibiotic justification checklist, and clinician AMS commitment forms. Pre and post-intervention prescribing practices were evaluated using retrospective chart audits. Final analysis is expected by March 2026.
RESULTS:
Pre-implementation data showed that inappropriate antibiotic prescribing was 84% (n = 282). Among these prescriptions, 61.9% of antibiotic combinations were unnecessary, despite 96.8% of patients having viral loads <1000 copies/mL, indicating good HIV viral suppression. The most frequently prescribed antibiotic classes were cephalosporins (93.8%), nitrofurans (93%), and fluoroquinolones (96.7%). Factors associated with inappropriate prescribing included review in urgent care (adjusted risk ratio 1.33, 95% CI 1.17–1.52, p = 0.001) and viral load >1000 copies/mL (ARR 1.17, 95% CI 1.06–1.30, p = 0.001).
CONCLUSIONS:
The results demonstrate that the impact of a combined bundle to reduce antibiotic misuse aligns with national efforts to combat AMR. Early results support integrating multifaceted AMS interventions into routine HIV care to advance national AMR goals
Inappropriate prescribing is a major contributor to Antimicrobial Resistance (AMR). A study conducted in an adult HIV clinic found inappropriate prescribing rates of 88%1. The alarming rates underscore the urgent need to address antibiotic misuse, further emphasising the importance of AMS (Antimicrobial Stewardship) to ensure antibiotics remain effective and are used judiciously.
OBJECTIVE:
To implement and evaluate the impact of a combined AMS intervention to reduce antibiotic prescribing rates in an adult HIV clinic from 82% to 50%
METHODS:
This quality improvement project was conducted in an adult HIV clinic through three phases: pre-implementation, implementation, and post-implementation. The intervention was informed by the Behaviour Change Wheel2 and used its intervention functions to guide the design of a multifaceted AMS bundle. Components included clinician education sessions, dissemination of updated outpatient prescribing guidelines, digital and printed AMR awareness materials for clinicians and patients, structured patient education, an antibiotic justification checklist, and clinician AMS commitment forms. Pre and post-intervention prescribing practices were evaluated using retrospective chart audits. Final analysis is expected by March 2026.
RESULTS:
Pre-implementation data showed that inappropriate antibiotic prescribing was 84% (n = 282). Among these prescriptions, 61.9% of antibiotic combinations were unnecessary, despite 96.8% of patients having viral loads <1000 copies/mL, indicating good HIV viral suppression. The most frequently prescribed antibiotic classes were cephalosporins (93.8%), nitrofurans (93%), and fluoroquinolones (96.7%). Factors associated with inappropriate prescribing included review in urgent care (adjusted risk ratio 1.33, 95% CI 1.17–1.52, p = 0.001) and viral load >1000 copies/mL (ARR 1.17, 95% CI 1.06–1.30, p = 0.001).
CONCLUSIONS:
The results demonstrate that the impact of a combined bundle to reduce antibiotic misuse aligns with national efforts to combat AMR. Early results support integrating multifaceted AMS interventions into routine HIV care to advance national AMR goals
| eISSN: | 2654-1459 |
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