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

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Chapter 3 Indicators for possible determinants of adherence clinic as low as one patient every five hours. This therefore becomes a useful discussion point for interventions in conjunction with the work load of the support staff and the following patient care indicators of waiting time. 10. Support staff patient load—Average number of AIDS patients per week per support staff. Rationale Source of data Data collection Computation Comments The more staff that are present to provide social and emotional support, the more likely the patient is to receive personal care and adherence support. Facility manager and observation. At the time of the visit ask about the number and type of staff routinely present for support services (adherence counselling, social and emotional counselling). Count the number of staff present during data collection to verify. The number of AIDS patients seen for consultative care per week is determined by looking in the attendance register (if there is a register present) for the last four weeks and dividing by four. Number of patients seen for AIDS consultative services in last week (both on ART and not on ART)/number of support staff. It may be more accurate to ask to see a roster of all staff and their hours for a week if this is available. It is important to only count each staff person once. For example, if a nurse does counselling and dispensing as well as nursing, this only counts as one staff member. 11. Presence of private space for counselling—Whether facility has a private space available for adherence counselling. Rationale Source of data Data collection Computation Comments A private space for counselling makes it more likely that patients can communicate openly and honestly with the counsellor. Private space does not necessarily mean a separate sound proof room. In practice, privacy means that the conversation cannot be overheard. Facility interview and observation. At the time of data collection, ask whether the facility has any private space for counselling and observe whether or not it is actually in use. Presence of actively used private space for counselling (Yes/No). Need to agree on a definition of what constitutes adequate privacy in a given setting. Private space does not necessarily mean a separate sound proof room. In practice, privacy means that the conversation cannot be overheard. In many crowded clinics this may be a quiet corridor or the far side of a room, but these spaces may not be available. In the four feasibility studies, the results of the number of facilities which provided access to private space varied between 13 and 19 out of 20 facilities sampled. 19
How to Investigate Adherence to Antiretroviral Treatment: An Indicator-Based Approach 12. Presence of laboratory— Does the facility have access to a functioning laboratory system for measuring CD4 counts or viral loads so that results can be ready for the patient's next routine visit? Rationale Source of data Data collection Computation Comments A functioning laboratory that can measure CD4 counts or viral loads in or near the facility or within the programme makes it more likely that these clinical markers will be monitored on a regular basis, which can promote discussion about adherence. Facility interview and observation. At the time of data collection, ask whether the facility has a functioning laboratory on-site, within the programme or within a five-minute walk that can produce CD4 or viral load results in time for the patient's next routine visit and whether the test or transport would cost the patient anything. If the laboratory is functioning and provides the test and transportation for free, then record Yes. Otherwise, record No. Laboratory needs to be functioning on the day of data collection Some facilities have access to a laboratory in a central facility within their programme and may either take blood to send to the facility or send the patient to the central facility for testing. From the patient’s point of view, the first option is much easier and less time consuming. If patients have to pay for their own transport, many may not be able to afford it. This then would not be defined as access. 13. CD4 and viral load testing rate. 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. Facility interview. While doing the facility interview, ask about the intended frequency for CD4 and viral load tests and whether the intended frequency is met. CD4 testing rate—The stated number of months between routine CD4 tests for each patient. Viral load testing rate—The stated number of months between routine viral load tests for each patient. Not all facilities do routine CD4 counts or viral loads for all patients. Many facilities may claim to do them routinely but in fact do not. This method does not allow for checking this. 20
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