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

How to Investigate Adherence to Antiretroviral Treatment in Health Facilities: Adherence Indicators
many facilities, most patients are seen every month. If this is the case, then one can use the
register of ART initiation. Count all the patients who have initiated ART from when the
clinic started to up to the end of the month you are sampling. The sample of patients should
be spread evenly across the time of initiation.
Situation 3. There is no attendance register and no ART Initiation Register, but patient
identifier number is in order of initiation
You need to check how the pharmacy and clinical notes are stored. It may be that they are
stored by patient identifier numbers and that the numbers correspond to the order of ART
initiation (the first patient to receive ART is number one, the second number two, etc.). If this
is the case, then you need to determine the identification number given to the last patient
starting ART at the end of the month for which you are interested, nd sample all patients who
had started before then.
Situation 4. There is no attendance register, and no ART Initiation Register. The patient
identification numbers are not allocated in order of ART initiation.
You need to check the total number of patients on ART now and the total number that were
on ART seven months before and then sample from all patients. The number sampled should
correspond to the proportion that had started before the end of the month you are interested
in. For example: if now there are 750 patients on ART and seven months ago there were 500.
To find a hundred patients who had initiated before seven months ago, you will need to
sample at least [(750/500) * 100] patients which is 150. It would be safer to sample 200.
Conclusion
Any set of circumstances may be met in practice. Based on experience to date (after 80
facilities in 4 countries), it has been possible to devise a sensible system for sampling records.
You may need to be creative. The key is to understand the recording and storage systems for
both the pharmacy records as well as the attendance register information.
Sampling for Exit Interviews
At each facility it will be necessary to interview patients as they leave. The last point of call
for the patient is usually the dispensary. It is challenging to find a suitable place for the
interviews because it should be—
• Close to the dispensary
• Afford adequate privacy
• Allow interviewer and interviewee space to sit down
• Have enough space so that more than one interview at a time can be conducted
Therefore one of the first activities is to find a suitable space for these interviews.
The sample of patients is a convenience sample. The aim is to interview 30 patients who are
on ART (except those who started on the day of data collection). If there are less than 30
patients that day then all should be interviewed. If there is a rush of patients, more than one
data collector should be assigned to interview them to avoid unnecessary delay to the patient.
In order to know which patient is on ART and should therefore be interviewed, it is useful to
ask the dispenser to request relevant patients to go for the interview.
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