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

More documents

Recommendations

Info

How to Investigate Adherence to Antiretroviral Treatment in Health Facilities: Adherence Indicators Record Keeping 17. The percentages of facilities with a functioning clinic attendance register showing all patients who visited each day 18. The percentage of facilities with an appointment book or other appointment system showing all patients due for clinic attendance each day Rationale Source of data Data collection Computation Comments Without a system to know who is expected and who has already kept their appointment, it is not possible to monitor whether patients have come when they were scheduled and therefore not possible to contact them and remind them of their missed appointment Facility interview While doing the facility interview ask to look at the appointment and attendance and appointment systems and check for whether it is being used successfully on the day of the interview Clinic attendance register—The presence of a functioning clinic attendance register. Appointment book—The presence of a functioning appointment book system. It is important to check whether the system is functioning. It would help to ask who is expected at the next clinic day, who came yesterday, and how many failed to turn up yesterday? If these questions can be answered easily, the system is working. Patient Care Indicator Determinants Information and Communication 17. Patient knowledge of ARV regimen—Percent of patients who know when to take each of their ARV medicine and how much to take each time Rationale Source of data Data collection Computation Comments Detailed knowledge of the correct ARV regimen is essential to adherence. Patient exit interviews Based on a sample of 30 patients attending on day of data collection (or all patients if < 30 attend that day)—For each ARV in treatment regimen, ask “Could you please tell me how many times a day you take this medicine, how much you take each time, and whether you take it before or after eating or with your meal?” Number of patients knowing all three aspects of all ARVs/number of patients asked) × 100 Need to determine correct treatment regimen for all ARVs used. 20
Chapter 3. Indicators for possible Determinants of Adherence This is asked during the exit interview leading up to the self report on missed doses over the last three days. So for each ARV in turn the interviewer asks when are you meant to take this medicine and then ask “and in the last three days have you missed any of your doses?” Cost to Patient in Time and Money 18. Patient waiting time—Average amount of time patients spend in the facility during a visit Rationale Source of data Data collection Computation Comments If patients have to spend a long time at the facility each time they have an appointment, they are less likely to be motivated or able to continue to attend appointments. Patient exit interview Based on a sample of 30 patients attending on day of data collection (or all patients if < 30 attend that day)—Ask when they arrived at the facility today and calculate the number of minutes between then and the time of leaving. In addition, record which services the patient received (clinical examination, laboratory test, adherence counselling, social service counselling, pharmacy dispensing) Sum across patients of number of minutes from entering the facility to leaving/number patients asked The arrival time may be approximate as people may not know. It can be asked in relation to the clinic opening time. An alternate would be following a number of patients through from arriving to leaving. 19. Patient travel time to care—Average amount of time spent travelling to health facility to receive care Rationale Source of data Data collection Computation Comments Length of time spent travelling to receive care can be a barrier to adherence. Patient exit interviews Based on a sample of 30 patients attending on day of data collection (or all patients if < 30 attend that day)—Ask how many minutes it took for the patient to travel to the health facility for this visit Sum across patients of number of minutes travelled for this visit/number of patients assessed The departure time and arrival time may be approximate as people may not know. It can be asked in relation to dawn or a cultural event such as an early prayers ceremony and the clinic opening time. The time should be recorded in minutes. In some cases, patients may travel the day before to get near the clinic, perhaps to stay with a relative. They may take the opportunity to do a little business such as selling produce. In this case the travelling time should be included, but not the time spent in the vicinity. 21
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
Page 23 and 24: Chapter 3. Indicators for possible
Page 25 and 26: Chapter 3. Indicators for possible
Page 27: Chapter 3. Indicators for possible
Page 31 and 32: CHAPTER 4. SURVEY DESIGN Sampling F
Page 33 and 34: Chapter 4. Survey Design Figure 1.
Page 35 and 36: CHAPTER 5. DATA COLLECTION TOOLS AN
Page 37 and 38: Chapter 5. Data Collection Tools an
Page 59 and 60: CHAPTER 6. PLANNING AND FIELD METHO
Page 61 and 62: Chapter 6. Planning and Field Metho
Page 67 and 68: CHAPTER 7. TRAINING OF DATA COLLECT
Page 69 and 70: Chapter 7. Training of Data Collect
Page 71 and 72: CHAPTER 8. DATA ENTRY AND DATA PROC
Page 73 and 74: Chapter 8. Data Entry and Data Proc
Page 75 and 76: Chapter 8. Data Entry and Data Proc
Page 78 and 79:
How to Investigate Adherence to Ant
Page 80 and 81:
Page 82 and 83:
CHAPTER 9. INTERPRETATION OF DATA A
Page 84 and 85:
Page 86 and 87:
CHAPTER 10. REPORT OUTLINE When the
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
How to investigate Adherence to Ant
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120:
show all

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

Create successful ePaper yourself

Delete template?

Save as template?