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

How to Investigate Adherence to Antiretroviral Treatment:
An Indicator-Based Approach
Chapter 2 describes the core indicators of adherence and how to collect them. These core
indicators are designed to be collectable almost anywhere. The three main areas are based
on:
Self-reported doses of ARV medicines missed over a recent period of time.
The number of days that ARV medicines were dispensed over the last six months.
The regularity of patient attendance at appointments.
Appendix 5 contains further complementary adherence indicators that may be collected
where the information sources exist.
Chapter 3 describes a number of indicators of possible determinants of good and poor
adherence. These include both facility-level indicators, such as drug supply, workload,
opening hours, patient waiting time, dispensing rates for ARV and non-ARV medicine and
quality of medicine labelling, and patient care indicators, such as patient travelling time,
travelling costs, and patient knowledge on dosage. Again, these are designed so that they
may be collected almost anywhere. In Appendix 6, further complementary determinants
indicators are described that may be collected where the information sources exist.
Chapter 4 goes into survey design and discusses how to sample facilities, retrospective
records and patients for interviewing.
Chapter 5 explains the data collection tools and how to fill them in, column by column.
Three main data collection tools are attached in Appendix 2:
1. A form for filling in details of patients' attendance and days of pills dispensed for 100
patients sampled randomly over the last six months.
2. An exit interview form for interviewing 30 patients as they leave the facility.
3. A facility interview sheet.
Chapter 6 explains how to plan for a survey and provides a checklist for the survey
coordinator. Chapter 7 gives sample training for data collectors, including a set of
PowerPoint slides in Appendix 3. Chapter 8 explains how to enter the data into the
computer and how the given spreadsheets do the analysis automatically. Chapter 9 helps to
interpret the data and gives examples of different adherence results, interprets possible
reasons and interventions, and Chapter 10 includes instructions on how to complete the
survey report template file, which is included on the accompanying CD-Rom and is outlined
in Appendix 4.
The basic premise of this document is that it is possible to narrow down the factors needed
to improve adherence. This manual describes how to measure adherence. We know that it
works with routine data and we encourage you to use this information in creating your own
programmes to improve ART adherence.
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