How to investigate levels of Adherence to antiretroviral ... - INRUD
How to investigate levels of Adherence to antiretroviral ... - INRUD
How to investigate levels of Adherence to antiretroviral ... - INRUD
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>How</strong> <strong>to</strong> Investigate <strong>Adherence</strong> <strong>to</strong> Antiretroviral Treatment:<br />
An Indica<strong>to</strong>r-Based Approach<br />
Health facility accessibility and infrastructure<br />
7. Extent <strong>of</strong> clinic hours—Number <strong>of</strong> hours clinic is open per week for routine AIDS<br />
care.<br />
8. Convenience <strong>of</strong> clinic hours—Whether clinic is open at least one evening or weekend<br />
day for routine AIDS care.<br />
Rationale<br />
Source <strong>of</strong> data<br />
Data collection<br />
Computation<br />
Comments<br />
If the facility opening hours correspond <strong>to</strong> the patient’s life or work schedule,<br />
then adherence <strong>to</strong> appointments is easier.<br />
Facility manager and patient interview.<br />
On the day <strong>of</strong> data collection, ask the facility manager which days and times the<br />
clinic is open for routine AIDS care (including clinical treatment <strong>of</strong> AIDS patients<br />
and dispensing <strong>of</strong> ARVs). Verify with patients during patient interviews.<br />
Extent <strong>of</strong> hours—Total number <strong>of</strong> hours clinic is routinely open for AIDS care.<br />
Convenience—If clinic is open at least one evening or weekend day.<br />
The manager may claim longer opening hours than are actually so in routine<br />
practice. Patient interviews can help <strong>to</strong> verify the information provided.<br />
The more the clinic is open the greater the convenience for the patient. This is particularly<br />
true if the patient is working on week days where a clinic time in the evenings or weekends<br />
would make attendance much easier. If the clinic is only open one day a week and if the<br />
patient misses that day, they have <strong>to</strong> wait seven days until the next opportunity.<br />
9. Clinician patient load—Average number <strong>of</strong> AIDS patients seen per clinician hour.<br />
Rationale<br />
Source <strong>of</strong> data<br />
Data collection<br />
Computation<br />
Comments<br />
Heavy patient volume can be a barrier <strong>to</strong> communication and adherence.<br />
Attendance records and interview with health facility administra<strong>to</strong>r.<br />
Determine how many patients were seen for consultative clinical visits during<br />
the previous month; also, determine the number <strong>of</strong> hours spent in clinic during<br />
the month by all the clinicians who provided these consultative services.<br />
Number <strong>of</strong> patients seen for AIDS consultative services in last month (both on<br />
ART and not on ART)/<strong>to</strong>tal number <strong>of</strong> hours worked by clinicians who provided<br />
these consultative services.<br />
It may be hard <strong>to</strong> distinguish which visits are for AIDS consultative care and <strong>to</strong><br />
determine which clinicians actually worked which hours; if necessary, compute<br />
the indica<strong>to</strong>r based on the last week although this may be less representative.<br />
In practice, the clinic may be open much less than it is in theory. For example, many clinics<br />
may theoretically be open all day, but in practice they may start late and finish by lunchtime.<br />
This means that during actual working the clinic is very busy and that only a little time can<br />
be given <strong>to</strong> each patient whereas if the patients were really able <strong>to</strong> attend during the<br />
theoretical working time, there would be much more clinician time per patient.<br />
In each <strong>of</strong> the four feasibility surveys, the number <strong>of</strong> patients per clinician hour was around<br />
two. This is much lower than expected because in practice all the work was crammed in<strong>to</strong> a<br />
few hours. <strong>How</strong>ever, in the busiest clinic the number was as high as 17 and in the least busy<br />
18