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

How to Investigate Adherence to Antiretroviral Treatment:
An Indicator-Based Approach
There is a difference between having a series of small gaps and one long gap in terms of
adherence. For this reason the other indicator measures the rate of patients with gaps in
treatment of 30 days or more. Between the four countries in the feasibility trial, this varied
from 2 to 18% of patients, but in the worst facility 60% of patients had such a gap. This may
be because people dropped out permanently through defaulting or death, or that they
remained in treatment. This would be an important follow-up question.
Indicator 3. Percentage of patients who experienced a gap in ARV
availability of more than 30 days in a row during a defined period
Rationale
Source of data
Data collection
A gap in medicine supply of more than 30 days has serious implications for
resistance and treatment failure.
Pharmacy records.
Based on the same sample of 100 patients and the same data on dates of
dispensing and number of days dispensed since the index visit.
Computation For individual patient: Discontinuation—If patient ever experiences a gap of > 30
days between the end of days’ supply in one dispensing (or end of total days’
supply available if ARVs remain from previous dispensings) and date of the next
dispensing
Comments
For facility: Percentage discontinuation (number of patients experiencing a gap in
ARV treatment > 30 days/number of patients) × 100.
This can be calculated automatically using the spreadsheet analysis tool.
Pitfalls
As with the previous indicator, identifying reliable patient-specific longitudinal
records may be a problem in some systems, if one visit is not recorded then the
patient will appear to have a gap of 30 days, so a low measure on the indicator
may reflect poor record keeping.
Patient attendance and defaulting measure
A missed appointment should trigger programme action to reach out to patients at risk of
defaulting on their treatment. However, because the patient may have had extra days of
medicine, attendance failure within three days of an appointment can also be a trigger point.
The two core performance indicators related to attendance are:
4. Percentage of patients who attend on or before the day of their appointment.
5. Percentage of patients who attend within three days of their appointment.
The purpose is to look at a visit the patient made, note when the next appointment was
made for, and then see if the patient kept the appointment. Because some programmes give
certain patients three months of medicine, it is necessary to review the records to see the
patient’s attendance four months before, see the date of the next appointment, and then note
whether the patient’s next visit was on or before that date (indicator 4), or within three days
of that date (indicator 5).
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