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

Chapter 1. Overview of Manual
Table 1. Adherence Values across Countries and Facilities
Median Percent Across All Facilities
(Minimum facility percent- Maximum facility percent)
Country Ethiopia Uganda Rwanda Kenya
Indicator
Attendance, Dispensing, and Gap (N = 1,989) (N =1,695) (N =1,602) (N = 1,265)
Exit Interviews (N = 565) (N = 408) (N = 285) (N = 373)
Full self-reported adherence in last
3 days from exit interview
96.6
(90–100)
96.7
(63–100)
100
(60–100)
96.6
(80–100)
Average percent days covered by
medicine dispensed
95
(89–99)
91
(77–97)
97
(88–100)
95
(53–100)
Percent of patients with ≥ 30 days
gap in medicines dispensed
9
(0–33)
18
(0–42)
2
(0–12)
16
(0–60)
Percent of patients attending clinic
appointment as scheduled
72
(58–99)
78
(15–100)
92
(38–100)
77
(46–96)
Percent of patients attending clinic
within three days of appointment
N/A = Data not collected
87
(72–99)
80
(20–100)
96
(67–100)
N/A
Usefulness of Pill Counts and Self-Report in Clinic Notes
Overall, only 15 percent of 6,551 patient records included a pill count (table 4). Therefore,
calculating adherence measures based on pill counts in medical and pharmacy records does
not appear to be widely applicable.
More records included a self-report adherence measure (45 percent overall), although this
measure was infrequently recorded in Rwanda (10 percent). However, the methods used to
derive these self-report measures varied, which makes comparisons problematic. In Ethiopia,
for example, the method of recording self-reported adherence was to use a “G” (good) to
indicate better than 95 percent adherence, an “F” (fair) for 85–95 percent or a “P” (poor) for
less than 85 percent. Of the 83 percent of records that included a self-report measure, 96
percent were rated “good.”
Table 2. Number of Records with Pill Counts and Self Reports
Ethiopia Uganda Rwanda Kenya Total
Number of records
examined 1,989 1,695 1,602 1,265 6,551
Percent of records with pill
counts 0 9 44 12 15
Percent of records with
self-reports 83 33 10 4 45
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