How to investigate Adherence to Antiretroviral Treatment ... - INRUD
How to investigate Adherence to Antiretroviral Treatment ... - INRUD
How to investigate Adherence to Antiretroviral Treatment ... - INRUD
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CHAPTER 2. CORE INDICATORS OF ADHERENCE<br />
The five core indica<strong>to</strong>rs of adherence with the alternate attendance indica<strong>to</strong>rs are—<br />
Self Report-based <strong>Adherence</strong> Measures from Exit Interviews<br />
1. Percentage of patients with full adherence <strong>to</strong> ART (i.e., no doses missed in the recall<br />
period, which is three days in the <strong>INRUD</strong>-IAA methodology)<br />
Dispensing-based <strong>Adherence</strong> Equals Measures<br />
2. Average percentage of days covered by ARVs dispensed for a sample of patients for a<br />
defined period (180 days)<br />
3. Percentage of patients who experienced a gap in ARV availability of more than 30<br />
days in a row during the same defined period<br />
Patient Attendance and Defaulting<br />
4. Percentage of patients who attend on or before the day of their appointment<br />
5. Percentage of patients who come within three days of their appointment<br />
Alternate Attendance Indica<strong>to</strong>rs<br />
6. Percentage of all visits in the last six months made before the days of medicine<br />
supplied at the previous visit have been consumed<br />
7. Percentage of all visits in the last six months made within three days of when the<br />
medicine supplied at the previous visit have been consumed<br />
Self Report-Based <strong>Adherence</strong> Measures from Exit Interviews<br />
A clinician or pharmacist can easily collect data for this indica<strong>to</strong>r by asking patients whether<br />
they have missed any doses of pills in the last three days, and if so, how many. For valid<br />
answers <strong>to</strong> this question the interviewer must appear nonjudgmental. The recommended way<br />
of asking it is “Many patients have troubles in taking their ARV doses as prescribed, how<br />
many of the ARV doses did you miss in the last three days?”<br />
Using clinical records <strong>to</strong> measure this indica<strong>to</strong>r is possible only if the question has<br />
been asked consistently and recorded routinely. Because of this, self report<br />
written in clinical notes is a complementary adherence indica<strong>to</strong>r. In practice,<br />
clinicians or pharmacists may have asked patients about their adherence but not<br />
recorded the answer. Also, the recall period they may have asked about may<br />
have varied anything from their adherence yesterday <strong>to</strong> since the last clinic visit.<br />
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