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

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
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