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

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How to Investigate Adherence to Antiretroviral Treatment in Health Facilities: Adherence Indicators 20. Patient travel cost for care—Average cost spent travelling to health facility to receive care Rationale Source of data Data collection Computation Cost of 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 much it cost for the patient to travel to the health facility for this visit. (in local currency) Sum across patients of cost of travelling to care for this visit /number of patients assessed Demographic Indicator Determinants 1. Average age of the patients 2. Gender—The percentage of patients who are female Rationale Source of data Data collection Computation Age and gender may both effect adherence Pharmacy notes These can be noted while checking the 100 sampled patient records for the adherence and defaulting indicators. Age: Sum all ages in years divided by number of patients Gender: (Sum all female patients divided by sum all patients) ×100 22
CHAPTER 4. SURVEY DESIGN Sampling Facilities Carrying out a survey of these indicators could be done in a single facility or in a sample of facilities. A survey to examine adherence in a large programme or system of care, such as the National AIDS Program, should include a minimum of 20 health facilities. If a system of care includes fewer facilities, then all of them should be included in a survey to measure system performance. A survey in a single facility only reflects the performance in that facility so it cannot be used to represent the performance in the country (unless it is the only facility providing treatment). Facilities are best selected randomly within specific strata defined by key characteristics such as geographic location, facility type, and facility management. The sample of facilities should be as randomly chosen as is feasible, taking into account the logistics of travel and the days the clinics are open. The retrospective sample of patients is 100, so that it is preferable to only choose facilities that had at least 100 patients on ARVs six months ago. However, if one wants to look at smaller facilities, this can be done but instead of sampling, all patients’ records should be looked at. The data to calculate each indicator should be collected at each facility. The sample sizes suggested are sufficient for a moderately reliable set of adherence measures at each facility (such as when monitoring performance over time) and a very reliable cross-sectional or longitudinal estimates of these measures in the system as a whole. An explanation of sample sizes and their accuracy is included in Appendix 4. Sampling Retrospective Patient Records The purpose of this exercise is to give us all the adherence indicators except the self report of the exit interview. As such it is the single most important exercise of the survey. Retrospective data from attendance records and pharmacy records are useful because they allow computation of indicators related to success of short-term and long-term adherence, defaulting, and clinical outcomes. It is necessary to take a sample of 100 patients who attended the clinic during the month seven months before. To end up with information on 100 patients, it is advisable to sample 120 patients from the list of those who attended during that month as some records may be unavailable. This means that if the data collection is taking place in June, you need the patients who attended in November the year before. This is because you need to follow the patient for six whole months and if the patient attended on the last day of November, then six months from then would be the last day of May. Depending on the month of data collection, the months to sample patient attendance from is documented in table 6. 23
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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
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Page 21 and 22: CHAPTER 3. INDICATORS FOR POSSIBLE
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CHAPTER 9. INTERPRETATION OF DATA A
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CHAPTER 10. REPORT OUTLINE When the
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