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

Appendix 2. Data Collection Forms
FACILITY Interview Side 2
Q12 Do you have a copy of the national ART treatment guidelines? Y / N
Q 13 Do you have a copy of a donor ART treatment guidelines? Y / N
Q14 Do you have a copy of guidelines on ART storage? Y / N
PATIENT CARE
Q 15 Do you follow a clinical guideline for starting patients on ART? Y / N
If so which guideline?
Q 16 How many days supply of ARVs are usually given to new patients?
Q 17 How many days supply of ARVs are usually given to experienced patients?
Q 18
How often do you typically order a CD4 count?
Pre-treatment assessment
Routinely Every How many months?
Monitoring of patients who deteriorate clinically
Not applicable, CD4 counts are not done
Q 19 What are criteria for ordering a viral load test? Pre-treatment assessment
Routinely Every How many months?
Monitoring of patients who deteriorate clinically
Not applicable, viral loads are not done
Q 20 Is there private space for Adherence Counseling? Y ? N
(Check while walking around the clinic)
(private space means a discreet area where a conversation with a patient cannot be overheard)
Q 21 Does the ART program provide: Child Care? Y/N/S for sometimes:
Food for patients? Y/N/S for sometimes:
Q 22
Does the ART program have a formal system for linking patients
with other persons living with HIV as support partners? Y/N/S for sometimes:
Q 23 Does the ART program have connection with the local community? Y/N:
(Churches or other organizations)
Q 24
Do you have a functioning laboratory system for measuring CD4 counts, so that results can
be ready for the patient's next routine visit?
Y/N
Q 25 Is both the test and transport for the test free for patients Y/N
Patients have access to a laboratory (If Q23 is "Y" AND Q24 is"N" then Y, otherwise N)
89