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

More documents

Recommendations

Info

How to investigate Adherence to Antiretroviral Treatment in Health Facilities: Adherence Indicators Facility Services and Contact with the Community 13. The percentage of facilities that provide food for patients 14. The percentage of facilities that have a formal system for linking patients with other persons living with HIV as support partners 15. The percentage of facilities that have connection with the local community such as churches or other organizations 3. Complementary Demographic Indicators 1. Tuberculosis status—Percentage of patients with TB comorbidity 2. WHO disease stage at initiation of ARVs—Percentage of patients diagnosed as stage I, II, III, and IV at initiation 1. Complementary Facility Indicators • Laboratory tests CD4 and viral load testing rate— 1. Percent of patients with documented CD4 test results at initiation of treatment 2. Percent of patients with documented CD4 test results in last six months 3. Percent of patients with documented viral load test in last six months 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. Clinical records Based on same sample of 100 patients find the clinical records and search for CD4 count at initiation and most recent CD4 count and viral load. Initiating CD4 testing rate—(number of patients with documented CD4 count at initiation of ART/number of patients searched) × 100 CD4 testing rate—(number of patients with documented CD4 count in last 6 months/number of patients searched) × 100 Viral load testing rate—(number of patients with documented viral load in last 6 months/number of patients searched) × 100 This will give a much more accurate assessment than the simple questioning during the facility interview. However, it does involve finding the clinical records for the 100 patients. Not all facilities do routine CD4 counts or viral loads for all patients. 108
Appendix 5. Complementary Indicators of Determinants of Adherence Clinical Outcomes 4. Achievement of CD4 target—Percent of patients achieving CD4 count > 350 cells per µl on most recent lab test in the last 6 months 5. Achievement of viral load target—Percent of patients achieving viral load counts < 400 copies per ml on most recent lab test in last 6 months Rationale Source of data Data collection Computation Comments Increase in CD4 and reduction in viral load are the primary outcomes intended for ARV therapy. If resources permit, routine monitoring of CD4 and viral load are the best ways to measure the clinical impact of ARV therapy and, indirectly, adherence. Clinical records Based on same sample of 100 patients find the clinical records and search for most recent CD4 count and viral load. Record whether they are more or less than 350 cells per µl for the CD4 and < 400 copies per ml for viral load. CD4 target—(number of patients with documented CD4 count on most recent lab test in the last six months > 350 cells per µl/number of patients with a lab test result) × 100 Viral load target—(number of patients with documented viral load test on most recent lab test in the last 6 months < 400 copies per ml/number of patients with a lab test result) × 100 This is only partly relevant because CD4 counts are affected by other factors such as length of time on treatment and by other infections. Therefore there may be other reasons for levels other than adherence. Guidelines 6. The percentage of facilities with a copy of the national ART guidelines 7. The percentage of facilities with a copy of a donor ART guidelines 8. The percentage of facilities with a copy of guidelines on ART storage 9. The percentage of facilities that follow a clinical guideline for starting patients on ART 109
Page 1 and 2:
How to investigate Adherence to Ant
Page 3 and 4:
ACKNOWLEDGEMENTS This manual has be
Page 5 and 6:
ACRONYMS AIDS ART ARV HIV IAA IHCAR
Page 7 and 8:
CONTENTS Acknowledgements .........
Page 9 and 10:
INTRODUCTION Collecting data on adh
Page 11 and 12:
CHAPTER 1. OVERVIEW OF MANUAL The 2
Page 13 and 14:
Chapter 1. Overview of Manual Table
Page 15 and 16:
CHAPTER 2. CORE INDICATORS OF ADHER
Page 17 and 18:
Chapter 2. Core Indicators of Adher
Page 19 and 20:
Chapter 2. Core Indicators of Adher
Page 21 and 22:
CHAPTER 3. INDICATORS FOR POSSIBLE
Page 23 and 24:
Chapter 3. Indicators for possible
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
CHAPTER 4. SURVEY DESIGN Sampling F
Page 33 and 34:
Chapter 4. Survey Design Figure 1.
Page 35 and 36:
CHAPTER 5. DATA COLLECTION TOOLS AN
Page 37 and 38:
Chapter 5. Data Collection Tools an
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
CHAPTER 6. PLANNING AND FIELD METHO
Page 61 and 62:
Chapter 6. Planning and Field Metho
Page 63 and 64:
Chapter 6. Planning and Field Metho
Page 65 and 66: Chapter 6. Planning and Field Metho
Page 67 and 68: CHAPTER 7. TRAINING OF DATA COLLECT
Page 69 and 70: Chapter 7. Training of Data Collect
Page 71 and 72: CHAPTER 8. DATA ENTRY AND DATA PROC
Page 73 and 74: Chapter 8. Data Entry and Data Proc
Page 75 and 76: Chapter 8. Data Entry and Data Proc
Page 78 and 79: How to Investigate Adherence to Ant
Page 82 and 83: CHAPTER 9. INTERPRETATION OF DATA A
Page 86 and 87: CHAPTER 10. REPORT OUTLINE When the
Page 100 and 101: How to investigate Adherence to Ant
Page 120: How to investigate Adherence to Ant
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?