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

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Appendix 6 Complementary indicators of determinants of adherence 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 6 months. 5. Achievement of viral load target—Percentage of patients achieving viral load counts 350 cells per µl/number of patients with a laboratory test result) × 100. Viral load target—(number of patients with documented viral load test on most recent laboratory test in the last 6 months < 400 copies per ml/number of patients with a laboratory test result) × 100. This is only partly relevant because CD4 counts are affected by other factors, such as length of time on treatment and by other infections. Therefore there may be other reasons for levels than adherence. Guidelines 6. The percentage of facilities with a copy of the national ART guidelines 7. The percentage of facilities with a copy of a donor ART 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 145
How to Investigate Adherence to Antiretroviral Treatment: An Indicator-Based Approach Rationale Source of data Data collection Computation Comments To provide optimal care in line with national policies it is advantageous to have guidelines that can be followed. Facility interview. While doing the facility interview ask to see copies of the different guidelines. If you can’t hold them in your hand they are not there. National ART treatment guidelines—The presence of a national ART treatment guidelines. Donor ART treatment guidelines—The presence of a donor ART treatment guidelines. ART storage guidelines—The presence of an ART storage guidelines. Clinical guidelines for starting patients on ART—Whether the facility manager says that the facility follows the clinical guidelines for starting patients on ART. The presence of written guidelines does not mean they are being followed. 2. Quality of treatment 10. Adherence to STGs—Percentage of patients whose current treatment is consistent with national STGs Rationale Patients treated according to established guidelines for ARVs are more likely to be adherent to care. Source of data Clinical records for the sample of 100 patients in indicators 4–10. Data collection Computation Comments Patient clinical records are examined to determine if current treatment is consistent with national STG for selection and dosing of ARVs. (Number of patients whose last treatment was consistent with STGs/number of patients records examined) × 100. Need to prepare a list of recommended STG regimens in the system of care. This may be difficult for data collectors to record reliably. In practice, it may be better to record each patient’s regimen for later evaluation. Number of 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. 146
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WHO/EMP/MIE/2011.1 How to Investiga
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CONTENTS Acknowledgements .........
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6 CHAPTER 6 --- Planning and field
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