title: Simplified methods of determining treatment retention in Malawi: ART cohort reports vs. pharmacy stock cards.
abstract: METHODS
  Rapid scale-up of antiretroviral therapy (ART) has challenged the health system in Malawi to monitor large numbers of patients effectively.
  
  
  OBJECTIVE
  To compare two methods of determining retention on treatment: quarterly ART clinic data aggregation vs. pharmacy stock cards.
  
  
  METHODS
  Between October 2010 and March 2011, data on ART outcomes were extracted from monitoring tools at five facilities. Pharmacy data on ART consumption were extracted. Workload for each method was observed and timed. We used intraclass correlation and Bland-Altman plots to compare the agreeability of both methods to determine treatment retention.
  
  
  RESULTS
  There is wide variability between ART clinic cohort data and pharmacy data to determine treatment retention due to divergence in data at sites with large numbers of patients. However, there is a non-significant trend towards agreeability between the two methods (intraclass correlation coefficient > 0.9; P > 0.05). Pharmacy stock card monitoring is more time-efficient than quarterly ART data aggregation (81 min vs. 573 min).
  
  
  CONCLUSIONS
  In low-resource settings, pharmacy records could be used to improve drug forecasting and estimate ART retention in a more time-efficient manner than quarterly data aggregation; however, a necessary precondition would be capacity building around pharmacy data management, particularly for large-sized cohorts.
authors.affiliation: Dignitas International, Zomba, Malawi ; Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada ; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A K
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Dignitas International, Zomba, Malawi ; University of Malawi, Chancellor College, Zomba, Malawi.
authors.forename: E
authors.initials: E
authors.lastname: Singogo
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: R
authors.initials: R
authors.lastname: Changamire
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: Y E C
authors.initials: YE
authors.lastname: Ratsma
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: J-M
authors.initials: JM
authors.lastname: Tassie
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
keywords: ART retention; Malawi; drug forecasting; monitoring and evaluation of HIV programme