How to investigate levels of Adherence to antiretroviral ... - INRUD
How to investigate levels of Adherence to antiretroviral ... - INRUD
How to investigate levels of Adherence to antiretroviral ... - INRUD
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<strong>How</strong> <strong>to</strong> Investigate <strong>Adherence</strong> <strong>to</strong> Antiretroviral Treatment:<br />
An Indica<strong>to</strong>r-Based Approach<br />
2C. Patient exit interviews<br />
EXIT INTERVIEWS Side 1<br />
Facility Name<br />
Date<br />
Facility #<br />
A B C D E F H I J K L M N<br />
Pt #<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
9<br />
10<br />
11<br />
12<br />
13<br />
14<br />
15<br />
16<br />
17<br />
18<br />
19<br />
20<br />
21<br />
22<br />
23<br />
24<br />
25<br />
26<br />
27<br />
28<br />
29<br />
30<br />
Age in<br />
Yrs<br />
Gender,<br />
M / F<br />
Occupation<br />
Normal<br />
activity Y<br />
/ N<br />
Months<br />
on trt.<br />
Cost<br />
home <strong>to</strong><br />
clinic<br />
106<br />
Time<br />
home <strong>to</strong><br />
clinic (in<br />
mins)<br />
Time in<br />
clinic<br />
<strong>to</strong>day (in<br />
mins)<br />
All ARVS<br />
dispensed<br />
Y/ N<br />
All Non<br />
ARVS<br />
dispensed<br />
Y / N<br />
All ARVs<br />
well<br />
labelled<br />
Y/N<br />
All other<br />
Meds well<br />
labelled<br />
Y / N
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