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

A.5
APPENDIX 5 --- Complementary indicators of
adherence
Pill count-based adherence measures
Pill counts are used by some ART programmes to compare a patient’s actual and expected
consumption since the pharmacy last dispensed the medicine. If records include pill counts,
the data can be used to calculate the pill count adherence measures. Because pill count
recording is relatively rare, these indicators are only collected where possible.
Pill Count 1. Full adherence (pill count)—Percentage of patients with perfect recent
adherence to ARV treatment
Pill Count 2. Average adherence (pill count)—Average percentage of recent ARV doses
taken
Rationale
Source of data
Data collection
Computation
Comments and
pitfalls
Some programmes use pill counts to monitor adherence. Pill counts at two
consecutive visits can be used to estimate adherence between those two visits.
Pill counts from clinical or pharmacy records.
Based on record review of the same systematic sample of 100 patients used
for the core adherence indicators.
Data are needed on both the total number of pills taken home during the
previous visit (including pills remaining in the bottle at that time plus newly
dispensed pills that were added) and the number of pills remaining in the
bottle brought to this visit.
Consumption rate for each patient = (number of days of pills taken home in
previous visit - number of days of pills remaining in bottle this visit)/(number
of days that have elapsed since previous visit) × 100.
Note: If any consumption rate is >100 percent, then change it to 100 percent.
Full adherence—(Number of patients for whom consumption rate equals 100
percent /number of patients with pill count data).
Average adherence—(Sum of consumption rates across all patients/number of
patients with pill count data).
Some patients dispose of medicines if they know that pill counts will be
conducted at the clinic. Pill counts require considerable effort. If clinics already
count pills, this method can provide alternate adherence measures. If a patient
is taking > 1 ARV, these indicators should be calculated separately for each
medication.
Self report-based adherence measures from clinical or pharmacy
records
When collected from patient exit interviews, this is a core indicator where the question and
mode of asking has been standardized. Using clinical records to measure this indicator is
possible only if the question has been asked consistently and recorded routinely. For this
reason the self report written in clinical notes is a complementary adherence indicator. In
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