Moderators of Fidelity to Praziquantel Dispensing Guidelines in Zimbabwean Retail Pharmacists

Abstract

Background: Globally, 260 million people live with schistosomiases, with 90% of these cases found in sub-Saharan countries, with Zimbabwe also facing a high prevalence of heavy infection. The treatment of choice for schistosomiasis is praziquantel and fidelity to the correct dosage is integral to compliance and treatment outcomes. The study sought to investigate the relationship between the implementation fidelity to praziquantel dispensing guidelines and their moderating factors, in retail pharmacists in Zimbabwe registered in the year 2021. This was done by; finding the implementation fidelity to praziquantel dispensing guidelines, describing the moderating factors of the implementation fidelity, and investigating the relationship between the moderating factors and the implementation fidelity of Zimbabwe retail pharmacists. Method: A cross-sectional, analytical study design was employed on 301 participants who were selected from retail pharmacists in Zimbabwe registered in 2021. Carroll’s framework for implementation fidelity was adapted and developed for the data collection tool, data analysis, and interpretation. Fidelity scores were computed from the aspects of adherence (content, coverage, and frequency), and the corresponding moderating factors. Logistic regressions were used to determine how the moderating factors related to implementation fidelity. Results: The study comprised 51.8% females and 48.2% males. The median implementation fidelity score (IQR) was 53.3% (43.33, 66.67). The results indicated that the implementation fidelity was significantly associated with the following moderating factors showing the significance (p < 0.05), facilitation strategies (cOR: 2.70; 95% CI: 1.50-486), quality of delivery (p = 0.053) and dosing practice (p < 0.001). However, after adjusting for socio- demographic factors, only facilitation strategies (cOR: 3.35; 95% CI: 1.58-7.05), participants' responsiveness (cOR: 1.83; 95% CI: 1.06-3.16), and the dosing practice (p = 0.002) were significant with implementation fidelity. Conclusion: The low implementation fidelity to the WHO recommended guidelines for praziquantel dosing adherence (compliance > 75%) would suggest that treatment could be compromised, and highlights poor compliance with the guidelines. Thus, negatively impacting the required health outcomes of patients. Effective and efficient communication methods can be used to improve the implementation fidelity of the recommended guidelines.