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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Chalker
John C
JC
Center for Pharmaceutical Management, Management Sciences for Health, Arlington Virginia, USA. jchalker@msh.org
Andualem
Tenaw
T
Gitau
Lillian N
LN
Ntaganira
Joseph
J
Obua
Celestino
C
Tadeg
Hailu
H
Waako
Paul
P
Ross-Degnan
Dennis
D
D000328:Adult; D000351:Africa, Eastern; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003625:Data Collection / Q000379:methods* / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies
D044966:Anti-Retroviral Agents