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

How to Investigate Adherence to Antiretroviral Treatment in Health Facilities: Adherence Indicators
12. Presence of laboratory—Does the facility have access to a functioning laboratory system
for measuring CD4 counts or viral loads so that results can be ready for the patient's next
routine visit?
Rationale
Source of data
Data collection
Computation
Comments
A functioning laboratory that can measure CD4 counts or viral loads in or near the
facility or within the programme makes it more likely that these clinical markers will
be monitored on a regular basis, which can promote discussion about adherence.
Facility interview and observation
At the time of data collection, ask whether the facility has a functioning laboratory
on-site, within the programme or within a five minutes’ walk that can produce CD4
or viral load results in time for the patient's next routine visit and whether the test
or transport would cost the patient anything.
If the laboratory is functioning and provide the test and transportation for free, then
record Yes. Otherwise, record No.
Laboratory needs to be functioning on the day of data collection
Some facilities have access to a laboratory in a central facility within their programme and
may either take blood to send to the facility or send the patient to the central facility for
testing. From the patient’s point of view, the first option is much easier and less time
consuming. If patients have to pay for their own transport, many may not be able to afford it.
This then would not be defined as access.
13. CD4 and viral load testing rate
Rationale
Source of data
Data collection
Computation
Comments
Increase in CD4 count over time is an indirect measure of success in controlling
HIV; routine testing for CD4 can assist in adherence monitoring
Facility interview
While doing the facility interview, ask about the intended frequency for CD4 and
viral load tests and whether the intended frequency is met.
CD4 testing rate—The stated number of months between routine CD4 tests for
each patient
Viral load testing rate—The stated number of months between routine viral load
tests for each patient
Not all facilities do routine CD4 counts or viral loads for all patients. Many facilities
may claim to do them routinely but in fact do not. This method does not allow for
checking this.
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