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

How to Investigate Adherence to Antiretroviral Treatment in Health Facilities: Adherence Indicators
There is a difference between having a series of small gaps and one long gap in terms of
adherence. For this reason the other indicator measures the rate of patients with gaps in
treatment of 30 days or more. Between the four countries in the feasibility trial, this varied
from 2 percent to 18 percent of patients, but in the worst facility 60 percent of patients had
such a gap. This may be because they dropped out permanently through defaulting or death,
or that they remained in treatment. This would be an important follow-up question.
Indicator 3. Percentage of patients who experienced a gap in ARV availability of more
than 30 days in a row during a defined period.
Rationale
Source of data
Data collection
Computation
Comments
Pitfalls
A gap in medicine supply of more than 30 days has serious implications for
resistance and treatment failure
Pharmacy records
Based on the same sample of 100 patients and the same data on dates of
dispensing and number of days dispensed since index visit
For individual patient: Discontinuation—If patient ever experiences a gap of
> 30 days between the end of days’ supply in one dispensing (or end of total
days’ supply available if ARVs remain from previous dispensings) and date
of the next dispensing
For facility: Percent discontinuation (number of patients experiencing a gap
in ARV treatment > 30 days/number of patients) × 100
This can be calculated automatically using the spreadsheet analysis tool
As with the previous indicator, identifying reliable patient-specific
longitudinal records may be a problem in some systems, if one visit is not
recorded then the patient will appear to have a gap of 30 days, so a low
measure on the indicator may reflect poor record keeping.
Patient Attendance and Defaulting Measure
A missed appointment should trigger programme action to reach out to patients at risk of
defaulting on their treatment. However, because the patient may have had extra days of
medicine, attendance failure within three days of an appointment can also be a trigger point.
The two core performance indicators related to attendance are—
4. Percentage of patients who attend on or before the day of their appointment
5. Percentage of patients who attend within three days of their appointment
The purpose is to look at a visit the patient made, note when the next appointment was made
for, and then see if the patient kept the appointment. Because some programmes give certain
patients three months of medicine, it is necessary to review the records to see the patient’s
attendance four months before, see the date of the next appointment, and then note whether
the patient’s next visit was on or before that date (indicator 4), or within three days of that
date (indicator 5).
When filling in the dispensing data collection form, alternate attendance indicators can be
calculated easily. This means that we have two alternative attendance indicators—
10