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

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9 CHAPTER 9 --- Interpretation of data and followon questions The pattern of survey results may give clues as to the reason for poor adherence at that facility and therefore help to guide appropriate interventions to improve the situation. It is important to present the results to key stakeholders and discuss the reasons for the results. Remember that the results are only indicators and in themselves only suggestive; the reasons need investigating. For all the retrospective data, the results depend on record keeping, and the problem may be nothing to do with patient behaviour but due to poor record keeping. One must not rush to judgement. Whenever feedback is given, start with positive findings. When being critical, be constructive. The key adherence indicators that related to clinical outcomes were the five core indicators chosen and reported on here: 1. Percentage of patients with full self-reported adherence in last three days (from exit interview) 2. Average percentage of days covered by medicine dispensed over six months 3. Percentage of patients with ≥ 30 days gap in medicines dispensed 4. Percentage of patients attending clinic appointment as scheduled 5. Percentage of patients attending clinic within three days of appointment Alternate indicators 6 and 7: 6. Percentage of all visits in the last six months made before the days of medicine supplied at the previous visit have been consumed 7. Percentage of all visits in the last six months made within 3 days of when the medicine supplied at the previous visit have been consumed These may present with different patterns of results which may suggest different causation that should be investigated. Examples of results’ patterns— If indicator 2 is high and indicator 3 is low (most days covered by medicine dispensed and very few gaps of 30 days or more) These results show that patients are receiving their medicine correctly and people are therefore attending the clinic when they should be. This is encouraging, but all these results really show is that the patients are receiving their medicines - but it does not mean that they are taking them correctly. A facility in the Uganda feasibility study showed the average 89
How to Investigate Adherence to Antiretroviral Treatment: An Indicator-Based Approach percentage of days covered by medicine dispensed over 6 months was 96.9%, while the percentage of patients with a gap of 30 days or more in medicines dispensed was 1.0%. The evidence for this comes through the self-report indicator 1 (percentage of patients with full self-reported adherence in last three days from exit interview). If this self-reported adherence indicator is also high, we can deduce that the facility is working well. If this indicator is lower, it suggests that patients need more counselling and support on the importance of correct medicines consumption. In the Ugandan facility, the percentage of patients with full self-reported adherence in the previous three days was 96.7%, showing that these patients were well counselled. If indicator 2 is low and 3 is high (only a few days covered by medicine dispensed and many gaps of 30 days or more) It shows that patients are not receiving enough of their medicine. If indicators 4 and 5 are low (many missing their appointment and not attending within three days) The most likely reason is that patients are missing a high percentage of their appointments (indicator 4 and alternate 6 would be low) and the fact that many have gaps of more than 30 days would suggest that people are missing appointments for a long time (indicator 5 would also be low). If this is the case, there is a need to ask why patients are missing their appointments. It may be for several reasons: The counselling sessions may not emphasize the importance of patients keeping their appointments. Appointments may not be given at the times the patients are able to come. The clinic may not be open when the patients are able to come. If patients miss their appointment, the clinic may not be open for another week. The date of the appointment may not have been made clear to the patients. There may be access problems, such as rainy season, impassable roads, excessive cost. There may have been stockouts of ARVs. Indicators 4 and 5 are high. If indicators 4 and 5 are not low then it suggests that the patients have come on time but they have not received their medicine. The likely problem is the medicine supply at the 90
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WHO/EMP/MIE/2011.1 How to Investiga
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CONTENTS Acknowledgements .........
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How to investigate levels of Adherence to antiretroviral ... - INRUD

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