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

How to Investigate Adherence to Antiretroviral Treatment in Health Facilities: Adherence Indicators
Conclusion from Feasibility Tests
The INRUD-IAA field tests examined four categories of indicators for adherence to ARV
medicines and treatment defaulting—
1. Self-reported adherence from exit interviews
2. Days supplied by medicine
3. Patient attendance
4. Pill counts and self-reports in clinic records
The first three methods offer feasible approaches to standardizing measures of adherence and
defaulting in low-resource settings. Pill counts are used too infrequently; whereas, selfreports
in clinic records appear more promising. However, the consistency of the datagathering
methods needs to be assessed.
The four field tests provide strong evidence that adherence targets can be met in resourcepoor
settings. However, in all countries, some facilities had low values, particularly for
dispensing-based adherence and patient attendance. Managers should examine the causes of
poor performance in these facilities and work with them to make improvements. Facilities
that are doing well can also share lessons on how to achieve exceptional performance. Only
by monitoring adherence and defaulting can we know where and what kind of interventions
are needed.
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