Article

Measuring adherence to antiretroviral treatment in resource-poor settings: the feasibility of collecting routine data for key indicators

Center for Pharmaceutical Management, Management Sciences for Health, Arlington Virginia, USA.
BMC Health Services Research (Impact Factor: 1.66). 02/2010; 10:43. DOI: 10.1186/1472-6963-10-43
Source: PubMed

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.

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    • "This study evaluated medication adherence and its association with CD4 cells response among HIV-positive patients receiving ART. The study reported mean adherence level (83.4%) that is below the required >95% necessary to achieve the goals of ART (Chalker et al., 2010; Arnsten et al., 2001; Paterson et al., 2000). This is similar to previous reports in Nigeria (Mukhtar et al., 2006; Olowookere et al., 2008; Agu et al., 2011). "
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    • "This was a cross-sectional study conducted in six ART facilities in each Ethiopia and Uganda between May and August 2007. The facilities were purposefully selected among 20 facilities in each country participating in a study to determine adherence performance (Chalker et al., 2010). The facilities in Ethiopia were all governmentally run, urban hospitals . "
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