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

How to Investigate Adherence to Antiretroviral Treatment:
An Indicator-Based Approach
Situation 2.
There is an attendance register, but it does not distinguish between those on
ART and those not on ART; however, there is an ART initiation register
In this situation, another method has to be found. As a last resort, this may include sampling
many more than 120 from the attendance register to end up with 100 patients on ART. In
many facilities, most patients are seen every month. If this is the case, then one can use the
register of ART initiation. Count all the patients who have initiated ART from when the
clinic started to up to the end of the month you are sampling. The sample of patients should
be spread evenly across the time of initiation.
Situation 3.
There is no attendance register and no ART initiation register, but patient
identifier number is in order of initiation
You need to check how the pharmacy and clinical notes are stored. It may be that they are
stored by patient identifier numbers and that the numbers correspond to the order of ART
initiation (the first patient to receive ART is number one, the second number two, etc.). If
this is the case, then you need to determine the identification number given to the last
patient starting ART at the end of the month for which you are interested, and sample all
patients who had started before then.
Situation 4.
There is no attendance register, and no ART initiation register. The patient
identification numbers are not allocated in order of ART initiation
You need to check the total number of patients on ART now and the total number that were
on ART seven months before and then sample from all patients. The number sampled
should correspond to the proportion that had started before the end of the month you are
interested in. For example: if now there are 750 patients on ART and seven months ago there
were 500. To find a hundred patients who had initiated before seven months ago, you will
need to sample at least [(750/500) * 100] patients which is 150. It would be safer to sample
200.
Conclusion
Any set of circumstances may be met in practice. Based on experience to date (after
80 facilities in 4 countries), it has been possible to devise a sensible system for sampling
records. You may need to be creative. The key is to understand the recording and storage
systems for both the pharmacy records as well as the attendance register information.
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