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

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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. 26
CHAPTER 5. DATA COLLECTION TOOLS AND HOW TO MODIFY, PRINT AND FILL THEM Customize the survey forms The first thing you will need to do is to customize the forms you are about to use. This mean: a) Formulating and entering the three medicine lists of up to ten each of your country’s first line adult and paediatric ARVs and key medicines used for opportunistic infections. b) Adding the list of types of health facilities and hospitals relevant to your survey. c) Adding the names of regions of your country or area from which you sampled. d) The types of facility management in your area, such as Government, NGO, Faith Based etc. e) The different sources of supplies of ARVs, such as Government, PEPFAR, Global fund etc f) Location names. At the moment these are urban and rural, but could be whatever is suitable for your area or country To do this open the file named: ‘Questionnaires Date entry and printing. xlt’ by right clicking your mouse on the file and opening it in that way. When you open this file three things will happen: i. One of two security warnings will pop up. Choose ‘Enable Macros’ Or choose ‘Enable this content’ 27
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
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Page 21 and 22: CHAPTER 3. INDICATORS FOR POSSIBLE
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Page 31 and 32: CHAPTER 4. SURVEY DESIGN Sampling F
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CHAPTER 10. REPORT OUTLINE When the
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