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

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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 91
How to Investigate Adherence to Antiretroviral Treatment: An Indicator-Based Approach performance. In addition, you may learn the reasons for their good performance, which can be shared with less well-performing facilities. The advantages of this approach will be that there is a strong possibility of finding reasons for the results and, in addition, that it will create motivation to design and adopt needed interventions. 92
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CONTENTS Acknowledgements .........
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