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

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A.6 APPENDIX 6 --- Complementary indicators of determinants of adherence There are many other pieces of information that can be collected that may affect a patient’s ability or willingness to adhere to treatment. Many of these can be collected from the facility interview but many others would need to come from clinical records. This therefore would include an extra level of effort of pulling out the relevant clinical records and reading them. So, these are complementary indicators as this level of effort is not needed to obtain the core adherence indicators. They may however be relevant for explaining the adherence results and designing suitable interventions. 1. Complementary facility indicators Laboratory Tests 1. CD4 testing rate—Percentage of patients with documented CD4 test at treatment initiation 2. CD4 testing rate—Percentage of patients with documented CD4 test results in last six months 3. Viral load testing rate—Percentage of patients with documented viral load test in last six months Clinical Outcomes 4. Achievement of CD4 target—Percentage of patients achieving CD4 count > 350 cells per µl on most recent laboratory test in the last six months 5. Achievement of viral load target—Percentage of patients achieving viral load counts < 400 copies per ml on most recent laboratory test in last six months Guidelines 6. The percentage of facilities with a copy of the national ART treatment guidelines 7. The percentage of facilities with a copy of a donor's ART treatment guidelines 8. The percentage of facilities with a copy of guidelines on ART storage 9. The percentage of facilities that follow a clinical guideline for starting patients on ART 2. Quality of treatment 10. Adherence to standard treatment guidelines (STGs)—Percentage of patients whose current treatment is consistent with national STGs 143
How to Investigate Adherence to Antiretroviral Treatment: An Indicator-Based Approach Days' Supply of Medicine Dispensed 11. The average number of days' supply of ARVs usually given to new patients 12. The average number of days' supply of ARVs usually given to experienced patients Facility Services and Contact with the Community 13. The percentage of facilities that provide food for patients 14. The percentage of facilities that have a formal system for linking patients with other persons living with HIV as support partners 15. The percentage of facilities that have connection with the local community, such as churches or other organizations 3. Complementary demographic indicators 1. Tuberculosis status—Percentage of patients with TB comorbidity 2. WHO disease stage at initiation of ARVs—Percentage of patients diagnosed as stage I, II, III and IV at initiation 1. Complementary Facility Indicators Laboratory tests CD4 and viral load testing rate: 1. Percentage of patients with documented CD4 test results at initiation of treatment. 2. Percentage of patients with documented CD4 test results in last six months. 3. Percentage of patients with documented viral load test in last six months. Rationale Source of data Data collection Computation Comments Increase in CD4 count over time is an indirect measure of success in controlling HIV. Routine testing for CD4 can assist in adherence monitoring. Clinical records. Based on same sample of 100 patients find the clinical records and search for CD4 count at initiation and most recent CD4 count and viral load. Initiating CD4 testing rate—(number of patients with documented CD4 count at initiation of ART/number of patients searched) × 100. CD4 testing rate—(number of patients with documented CD4 count in last 6 months/number of patients searched) × 100. Viral load testing rate—(number of patients with documented viral load in last 6 months/number of patients searched) × 100. This will give a much more accurate assessment than the simple questioning during the facility interview. However, it does involve finding the clinical records for the 100 patients. Not all facilities do routine CD4 counts or viral loads for all patients. 144
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CONTENTS Acknowledgements .........
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6 CHAPTER 6 --- Planning and field
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How to investigate levels of Adherence to antiretroviral ... - INRUD

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