Measuring adherence to antiretroviral treatment in resource-poor settings: The feasibility of collecting routine data for key indicators
Open Access
- 19 February 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Health Services Research
- Vol. 10 (1), 43
- https://doi.org/10.1186/1472-6963-10-43
Abstract
An East African survey showed that among the few health facilities that measured adherence to antiretroviral therapy, practices and definitions varied widely. We evaluated the feasibility of collecting routine data to standardize adherence measurement using a draft set of indicators. Targeting 20 facilities each in Ethiopia, Kenya, Rwanda, and Uganda, in each facility we interviewed up to 30 patients, examined 100 patient records, and interviewed staff. In 78 facilities, we interviewed a total of 1,631 patients and reviewed 8,282 records. Difficulties in retrieving records prevented data collection in two facilities. Overall, 94.2% of patients reported perfect adherence; dispensed medicine covered 91.1% of days in a six month retrospective period; 13.7% of patients had a gap of more than 30 days in their dispensed medication; 75.8% of patients attended clinic on or before the date of their next appointment; and 87.1% of patients attended within 3 days. In each of the four countries, the facility-specific median indicators ranged from: 97%-100% for perfect self-reported adherence, 90%-95% of days covered by dispensed medicines, 2%-19% of patients with treatment gaps of 30 days or more, and 72%-91% of appointments attended on time. Individual facilities varied considerably. The percentages of days covered by dispensed medicine, patients with more than 95% of days covered, and patients with a gap of 30 days or more were all significantly correlated with the percentages of patients who attended their appointments on time, within 3 days, or within 30 days of their appointment. Self reported recent adherence in exit interviews was significantly correlated only with the percentage of patients who attended within 3 days of their appointment. Field tests showed that data to measure adherence can be collected systematically from health facilities in resource-poor settings. The clinical validity of these indicators is assessed in a companion article. Most patients and facilities showed high levels of adherence; however, poor levels of performance in some facilities provide a target for quality improvement efforts.This publication has 29 references indexed in Scilit:
- Measuring adherence to antiretroviral treatment in resource-poor settings: The clinical validity of key indicatorsBMC Health Services Research, 2010
- Pharmacy Refill Adherence Compared with CD4 Count Changes for Monitoring HIV-Infected Adults on Antiretroviral TherapyPLoS Medicine, 2008
- Adherence to HAART therapy measured by electronic monitoring in newly diagnosed HIV patients in BotswanaEuropean Journal of Clinical Pharmacology, 2007
- Viability and effectiveness of large-scale HIV treatment initiatives in sub-Saharan Africa: experience from western KenyaAIDS, 2006
- Adherence to antiretroviral HIV drugs: how many doses can you miss before resistance emerges?Proceedings. Biological sciences, 2005
- Adherence to MedicationThe New England Journal of Medicine, 2005
- Evaluation of antiretroviral therapy results in a resource‐poor setting in Blantyre, MalawiTropical Medicine & International Health, 2005
- Variations in Patients’ Adherence to Medical RecommendationsMedical Care, 2004
- Working Across Boundaries: Collaboration in Public ServicesHealth & Social Care in the Community, 2003
- Individual and System Level Factors Associated with Treatment Nonadherence in Human Immunodeficiency Virus-infected Men and WomenAIDS Patient Care and STDs, 2002