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

Chapter 9. Interpretation of Data and Follow-On Questions
If indicator 2 is low and 3 is high (only a few days covered by medicine dispensed
and many gaps of 30 days or more)
It shows that patients are not receiving enough of their medicine.
If indicators 4 and 5 are low (many missing their appointment and not attending
within three days)
The most likely reason is that patients are missing a high percentage of their appointments
(indicator 4 and alternate 6 would be low) and the fact that many have gaps of more than 30
days would suggest that people are missing appointments for a long time (indicator 5 would
also be low). If this is the case, there is a need to ask why patients are missing their
appointments. It may be for several reasons—
• The counselling sessions may not emphasize the importance of patients keeping their
appointments
• Appointments may not be given at the times the patients are able to come
• The clinic may not be open when the patients are able to come
• If patients miss their appointment, the clinic may not be open for another week
• The date of the appointment may not have been made clear to the patients.
• There may be access problems, such as rainy season, impassable roads, excessive cost
• There may have been stock outs of ARVs
• Indicators 4 and 5 are high
If indicators 4 and 5 are not low then it suggests that the patients have come on time but they
have not received their medicine. The likely problem is the medicine supply at the facility.
This can be checked on during the facility interview and followed up in the pharmacy.
If indicators 2 and 3 are low, (few days covered by medicine dispensed but few gaps
of 30 days or more)
It shows that many patients are not receiving enough days of medicine, but there are only a
few that are missing them for a long period of time. In other words there will be several short
gaps rather than one large gap. This may be reflected in the following—
Indicator 4 is low and indicator 5 is high
If many patients are missing their given appointment but attending within three days (4 is low
and 5 is high), it indicates that many patients are missing their appointments, but attending
within three days. One explanation would be that patients have a few extra days of pills and
only attend when they have run out of their pills. However, this would result in indicator 2
being high (a high percentage of days covered by medicines dispensed). If indicator 2 is low
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