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

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Appendix 6 Complementary indicators of determinants of adherence Rationale Source of data Data collection Computation Comments The number of days of ARVs dispensed dictates how often the patient has to return to the clinic. The more frequent, the more time is sacrificed to treatment, but also the more contact the patient has with the clinic. Both of these factors may affect adherence. Facility Interview and Retrospective data form. While doing the facility interview ask whether the clinic has a normal protocol for the numbers of days of ARVs dispensed to new and to experienced patients. Also observe the most frequent numbers when filling in the retrospective data form. New Patients—The stated average number of days of ARVs dispensed to new patients. Experienced Patients—The stated average number of days of ARVs dispensed to experienced patients. This information can be checked while filling in the retrospective dispensing data form. If there is a disagreement in the results, what is found on the dispensing data form will be more accurate. 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. Rationale Source of data Data collection Computation Comments When poor patients start ART, their appetite improves and they start to put on weight. The increased appetite represents increased cost. This can be facilitated by the programme providing food to the patients during their first months of treatment. With chronic diseases by far the majority of the patient’s time is spent in the community rather than in the facility. Therefore community support and community linkages are key to helping the patient adhere. Facility interview. While doing the facility interview ask whether the clinic has a policy for giving food to patients; whether they have a formal system for linking patients with other persons living with HIV as support partners; and whether they have connection with the local community, such as churches or other organizations. Food—Does the facility provide food to patients? Linking patients with other persons living with HIV as support partners—Does the facility have a formal linking system? Linkage with the community—Does the facility have active links? This information can be checked for completeness by asking patients in the exit interviews. 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. 147
How to Investigate Adherence to Antiretroviral Treatment: An Indicator-Based Approach Rationale Source of data TB status and disease stage effect outcomes and may effect adherence. Clinical and pharmacy notes. Data collection TB status and disease stage at initiation can be noted while checking the 100 sampled patient records for the adherence and defaulting indicators. However the clinical records will need to be selected as well. Computation TB status—(Sum all patients with TB diagnoses at initiation divided by sum all patients) × 100. WHO disease stage—(Sum all patients with WHO stage I, II, III and IV at initiation divided by sum all patients) × 100. 148
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CONTENTS Acknowledgements .........
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6 CHAPTER 6 --- Planning and field
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