How to investigate levels of Adherence to antiretroviral ... - INRUD

Chapter 9
Interpretation of data and follow-on questions
facility. This can be checked on during the facility interview and followed up in the
pharmacy.
If indicators 2 and 3 are low, (few days covered by medicine dispensed but few
gaps of 30 days or more)
It shows that many patients are not receiving enough days of medicine, but there are only a
few that are missing them for a long period of time. In other words there will be several
short gaps rather than one large gap. This may be reflected in the following:
Indicator 4 is low and indicator 5 is high
If many patients are missing their given appointment but attending within three days (4 is
low and 5 is high), it indicates that many patients are missing their appointments, but
attending within three days. One explanation would be that patients have a few extra days
of pills and only attend when they have run out of their pills. However, this would result in
indicator 2 being high (a high percentage of days covered by medicines dispensed). If
indicator 2 is low (few days covered by medicine dispensed), then it means that patients are
coming after their pills have run out but are coming within 3 days.
These reasons need to be investigated. They could be because:
The counselling sessions may not emphasize the importance of patients keeping their
appointments.
Appointments may not be given at the times the patients are able to come.
The date of the appointment may not be being made clear to the patients.
Indicators 4 and 5 are low
With both 4 and 5 low, many patients are missing their appointments, not attending within 3
days, but attending in less than 30 days after their appointment. Again, the reasons need
investigating. It could easily be that the clinic is only open once a week, so if the
appointment is missed the patient cannot attend again for seven days.
Dissemination of results to key stakeholders
After the survey has been finished, it is advisable to hold a meeting of key stakeholders at
each facility where there seems to be a problem. At this meeting present the results and
discuss the possible causes to suggest recommendations for interventions to improve the
situation.
Wherever possible, provide feedback at all the facilities including those performing well. By
congratulating and reinforcing positive results, you may maintain or improve their
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