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

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How to Investigate Adherence to Antiretroviral Treatment in Health Facilities: Adherence Indicators Health Facility Accessibility and Infrastructure 7. Extent of clinic hours—Number of hours clinic is open per week for routine AIDS care 8. Convenience of clinic hours—Whether clinic is open at least one evening or weekend day for routine AIDS care Rationale Source of data Data collection Computation Comments If the facility opening hours correspond to the patient’s life or work schedule, then adherence to appointments is easier Facility manager and patient interview On the day of data collection, ask the facility manager which days and times the clinic is open for routine AIDS care (including clinical treatment of AIDS patients and dispensing of ARVs). Verify with patients during patient interviews. Extent of hours—Total number of hours clinic is routinely open for AIDS care Convenience—If clinic is open at least one evening or weekend day The manager may claim longer opening hours than are actually so in routine practice. Patient interviews can help to verify the information provided. The more the clinic is open the greater the convenience for the patient. This is particularly true if the patient is working on week days where a clinic time in the evenings or weekends would make attendance much easier. If the clinic is only open one day a week and if the patient misses that day, they have to wait seven days until the next opportunity. 9. Clinician patient load—Average number of AIDS patients seen per clinician hour Rationale Source of data Data collection Computation Comments Heavy patient volume can be a barrier to communication and adherence Attendance records and interview with health facility administrator Determine how many patients were seen for consultative clinical visits during the previous month; also, determine the number of hours spent in clinic during the month by all the clinicians who provided these consultative services Number of patients seen for AIDS consultative services in last month (both on ART and not on ART)/total number of hours worked by clinicians who provided these consultative services It may be hard to distinguish which visits are for AIDS consultative care and to determine which clinicians actually worked which hours; if necessary, compute the indicator based on the last week although this may be less representative In practice, the clinic may be open much less than it is in theory. For example, many clinics may theoretically be open all day, but in practice they may start late and finish by lunchtime. This means that during actual working the clinic is very busy and that only a little time can be given to each patient whereas if the patients were really able to attend during the theoretical working time, there would be much more clinician time per patient. In each of the four feasibility surveys, the number of patients per clinician hour was around two. This is much lower than expected because in practice all the work was crammed into a few hours. However, in the busiest clinic the number was as high as 17 and in the least busy clinic as low as one patient every five hours. This therefore becomes a useful discussion point for interventions in conjunction with the work load of the support staff and the following patient care indicators of waiting time. 16
Chapter 3. Indicators for possible Determinants of Adherence 10. Support staff patient load—Average number of AIDS patients per week per support staff Rationale Source of data Data collection Computation Comments The more staff that are present to provide social and emotional support, the more likely the patient is to receive personal care and adherence support. Facility manager and observation At the time of the visit ask about the number and type of staff routinely present for support services (adherence counselling, social and emotional counselling). Count the number of staff present during data collection to verify. The number of AIDS patients seen for consultative care per week is determined by looking in the attendance register (if there is a register present) for the last four weeks and dividing by four. Number of patients seen for AIDS consultative services in last week (both on ART and not on ART)/number of support staff It may be more accurate to ask to see a roster of all staff and their hours for a week if this is available It is important to only count each staff person once. For example, if a nurse does counselling and dispensing as well as nursing, this only counts as one staff member 11. Presence of private space for counselling—Whether facility has a private space available for adherence counselling Rationale Source of data Data collection Computation Comments A private space for counselling makes it more likely that patients can communicate openly and honestly with the counsellor. Private space does not necessarily mean a separate sound proof room. In practice, privacy means that the conversation cannot be overheard. Facility interview and observation At the time of data collection, ask whether the facility has any private space for counselling and observe whether or not it is actually in use. Presence of actively used private space for counselling (Yes/No) Need to agree on a definition of what constitutes adequate privacy in a given setting. Private space does not necessarily mean a separate soundproof room. In practice, privacy means that the conversation cannot be overheard. In many crowded clinics this may be a quiet corridor or the far side of a room, but these spaces may not be available. In the four feasibility studies, the results of the number of facilities which provided access to private space varied between 13 and 19 out of 20 facilities sampled. 17
Page 1 and 2: How to investigate Adherence to Ant
Page 3 and 4: ACKNOWLEDGEMENTS This manual has be
Page 5 and 6: ACRONYMS AIDS ART ARV HIV IAA IHCAR
Page 7 and 8: CONTENTS Acknowledgements .........
Page 9 and 10: INTRODUCTION Collecting data on adh
Page 11 and 12: CHAPTER 1. OVERVIEW OF MANUAL The 2
Page 13 and 14: Chapter 1. Overview of Manual Table
Page 15 and 16: CHAPTER 2. CORE INDICATORS OF ADHER
Page 17 and 18: Chapter 2. Core Indicators of Adher
Page 19 and 20: Chapter 2. Core Indicators of Adher
Page 21 and 22: CHAPTER 3. INDICATORS FOR POSSIBLE
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Page 31 and 32: CHAPTER 4. SURVEY DESIGN Sampling F
Page 33 and 34: Chapter 4. Survey Design Figure 1.
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Page 61 and 62: Chapter 6. Planning and Field Metho
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Page 71 and 72: CHAPTER 8. DATA ENTRY AND DATA PROC
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Chapter 8. Data Entry and Data Proc
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CHAPTER 9. INTERPRETATION OF DATA A
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CHAPTER 10. REPORT OUTLINE When the
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