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

CHAPTER 9. INTERPRETATION OF DATA AND FOLLOW-ON QUESTIONS
The pattern of survey results may give clues as to the reason for poor adherence at that
facility and therefore help to guide appropriate interventions to improve the situation. It is
important to present the results to key stakeholders and discuss the reasons for the results.
Remember that the results are only indicators and in themselves only suggestive; the reasons
need investigating. For all the retrospective data, the results depend on record keeping, and
the problem may be nothing to do with patient behaviour but due to poor record keeping. One
must not rush to judgement. Whenever feedback is given, start with positive findings. When
being critical, be constructive.
The key adherence indicators that related to clinical outcomes were the five core indicators
chosen and reported on here—
1. Percent of patients with full self-reported adherence in last three days (from exit
interview)
2. Average percent days covered by medicine dispensed over six months
3. Percent of patients with ≥ 30 days gap in medicines dispensed
4. Percent of patients attending clinic appointment as scheduled
5. Percent of patients attending clinic within three days of appointment
Alternate indicators 6 and 7—
6. Percentage of all visits in the last six months made before the days of medicine
supplied at the previous visit have been consumed
7. Percentage of all visits in the last six months made within 3 days of when the medicine
supplied at the previous visit have been consumed
These may present with different patterns of results which may suggest different causation
that should be investigated. Examples of results’ patterns—
If indicator 2 is high and indicator 3 is low (most days covered by medicine
dispensed and very few gaps of 30 days or more)
These results show that patients are receiving their medicine correctly and people are
therefore attending the clinic when they should be. This is encouraging, but all these results
really show is that the patients are receiving their medicines but it does not mean that they are
taking them correctly. A facility in the Uganda feasibility study showed the average percent
days covered by medicine dispensed over 6 months was 96.9 percent, while the percent of
patients with a 30 days or more gap in medicines dispensed was 1.0 percent
The evidence for this comes through the self-report indicator 1 (percentage of patients with
full self-reported adherence in last three days from exit interview). If this self-reported
adherence indicator is also high, we can deduce that the facility is working well. If this
indicator is lower, it suggests that patients need more counselling and support on the
importance of correct medicines consumption. In the Ugandan facility, the percent of patients
with full self-reported adherence in the last three days was 96.7 percent, showing that these
patients were well counselled.
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