How to investigate Adherence to Antiretroviral Treatment ... - INRUD

How to Investigate Adherence to Antiretroviral Treatment in Health Facilities: Adherence Indicators
Chapter 2 describes the core indicators of adherence and how to collect them. These core
indicators are designed to be collectable almost anywhere. The three main areas are based
on—
• Self-reported doses of ARV medicine missed over a recent period of time
• The number of days that ARV medicines were dispensed over the last six months
• The regularity of patient attendance at appointments.
In Appendix 4, further complementary adherence indicators are described which may be
collected where the information sources exist.
Chapter 3 describes a number of indicators of possible determinants of good and poor
adherence. These include both facility level indicators such as drug supply, workload,
opening hours, patient waiting time, dispensing rates for ARV and non-ARV medicine and
quality of medicine labelling, and patient care indicators such as patient travelling time,
travelling costs, and patient knowledge on dosage. Again, these are designed so that they may
be collected almost anywhere. In Appendix 5, further complementary determinants indicators
are described which may be collected where the information sources exist.
Chapter 4 goes into survey design and discusses how to sample facilities, retrospective
records and patients for interviewing.
Chapter 5 explains the data collection tools and how to fill them in, column by column. There
are three main data collection tools attached in Appendix 2—
1. A form for filling in details of patients attendance and days of pills dispensed for 100
patients sampled randomly over the last six months
2. An exit interview form for interviewing 30 patients as they leave the facility
3. A facility interview sheet
Chapter 6 explains how to plan for a survey and provides a checklist for the survey
coordinator. Chapter 7 gives sample training for data collectors, including a set of
PowerPoint slides in Appendix 3. Chapter 8 explains how to enter the data into the computer
and how the given spread sheets do the analysis automatically. Chapter 9 helps to interpret
the data and gives examples of different adherence results, interprets possible reasons and
interventions, and Chapter 10 includes an outline for reporting.
The implication of this document is that it is possible to narrow down the factors needed to
improve adherence. Here is a manual that describes how to measure adherence. We know
that it works with routine data and we encourage you to use this information in creating your
own programs to improve ART adherence.
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