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

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Chapter 5 Data collection tools and how to modify, print and fill them in Columns J and K Write the date of the next visit and the number of days of pills dispensed. Columns N and O Write the date of the next visit and the number of days of pills dispensed. Continue to write down these details for each visit up to the present day. Normally it will be 7 visits or fewer but there are spaces for 12 visits in case it is necessary. When you turn over the form, do not forget to write the patient identification number on the second side. Now look at the patient attendance four months ago as shown in Table 6 and look at the appointment the patient was given at that time at that attendance. If the data collection is in April 2008, look to see if the patient attended in December 2007. If so, what was the date of the next appointment given at the December visit? Then look and see if the patient attended that next appointment. BX BY BZ CA If yes If missed If missed Did patient attend 3 months ago Attended next appt after visit 3 months ago Attended in next 3 days after missed appt Attended in next 30 days after missed visit Column BX Did the patient attend around 3 months ago (e.g., December 2007)? Answer Yes or No. If the answer was No, you have finished. Leave all other columns (BY, BZ, and CA) blank. If the answer was Yes, then look for the date the patient was given for their next appointment after that and go on to the next columns. Column BY Did the patient attend on or before the date of the given next appointment (Yes/No)? (For example, did the patient attend the appointment given during the December 2007 visit?) Note: If there was no appointment given, you can see how many days of ARVs were given and calculate whether the patient attended on or before the last day that the pills would run out. Column BZ If the patient missed their appointment did they attend within the next three days of the missed appointment? (Yes/No). 51
How to Investigate Adherence to Antiretroviral Treatment: An Indicator-Based Approach Note: If the appointment was on the 11th and they came on the 14th, the answer would be Yes. If they attended on the 15th, the answer would be No. The system will validate that the data in columns BX, BY, BZ and CA to ensure that it is consistent. Filling in the exit interview forms The purposes of this form are to ask for self-report on adherence, as well as check how long patients spent at the clinic, how long it took to travel to the clinic, how many of their prescribed ARVs and other drugs were actually dispensed, whether the medicines are correctly labelled, whether the patient has experienced any adverse drug events in the last month, and whether they know how to take their medicine correctly. All questions will need to be asked in appropriate local languages. The uniform way of asking each question in the appropriate language needs to be agreed upon and written down. This can be done at the time of data collection training. The proposed patient indicators can also be used to assess adherence among paediatric patients. If the patient is a child who has been brought to the clinic by a caregiver, then there are two screening questions to ask the caregiver to see whether the child would be eligible for the survey. If the caregiver is not the one who usually gives the child medicine, then that child should not be included. (Patient exit interview form). It is desirable to conduct at least 30 exit interviews at each facility. If there are not 30 patients, then try to interview all the patients that visited that day. It is important to visit on a day when patients are expected. The patients you want to interview are those on ART, but not those who started ART the same day of data collection. The interview should be done sitting down in a comfortable spot. It will be most helpful to find a good place and ask the pharmacy dispenser to ask the relevant patients to go there for interview. The place should be near the pharmacy as this is the last place the patient usually visits before leaving the clinic. It is important to be pleasant and polite. You should speak in a language well known to the patient, and not be officious, or dress in a white coat, or speak with technical words. You must put the patient at their ease if you wish to get real information. The main point is to build a trust so that when you get to the final questions on whether they have missed any doses in the last three days they will give you an honest answer. The patient is under no obligation to speak to you, so you should introduce yourself with the important points: You are working with the Ministry of Health to try and help to improve services for people taking ARVs. It will only take a few minutes. 52
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CONTENTS Acknowledgements .........
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A.3 APPENDIX 3 --- Training slides
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