title: IMPLEMENTING TOOLS TO PROMOTE ADHERENCE TO ANTIRETROVIRAL THERAPY AT FACILITIES IN KENYA.
abstract: BACKGROUND
  Lack of effective systems and tools to identify and track defaulters are some of the factors that pose challenges in adherence monitoring for patients on anti-retroviral treatment (ART). An intervention was performed to introduce a facility-based appointment keeping system, and a revised clinic form to monitor patients' adherence to ART.
  
  
  OBJECTIVE
  To assess facility staff perceptions of, motivation for and self-reported practice in the implementation, and on the use of adherence-based indicators to inform decisions for performance improvement.
  
  
  METHODS
  Qualitative explorative study aiming to evaluate a quasi-experimental intervention.
  
  
  METHODS
  Six conveniently sampled health facilities in Kenya located in Central, Eastern and Rift Valley provinces.
  
  
  METHODS
  Thirty-six clinic staff members were interviewed, six at each facility, including facility managers, clinicians, nursing and pharmacy staff, counsellors, health records information officers and social workers. Analysis was performed in line with the Pettigrew and Whipp framework.
  
  
  RESULTS
  Providers perceived that the intervention had empowered them to assess their clinic's daily workload and to identify those patients who missed their appointments. Factors enhancing the positive uptake of the intervention included the availability of tools to monitor appointment keeping, training on adherence principles and supervisory support. Early detection of treatment defaulters helped the providers design targeted patient support to enhance appointment keeping.
  
  
  CONCLUSIONS
  The effect of the intervention led to implementation of changes within the clinic to enhance patients' appointment keeping and improve adherence to treatment. We expect the reported and observed changes to be sustainable as data generation and calculation of indicators to inform decision-making were performed by the providers themselves.
authors: L
authors: L
authors: Gitau
authors: P
authors: P
authors: Boruett
authors: S
authors: S
authors: Njogo
authors: P
authors: P
authors: Nguhiu
authors: C
authors: C
authors: Awour
authors: D
authors: D
authors: Kagai
authors: J
authors: J
authors: Chalker
authors: G
authors: G
authors: Tomson
authors: T
authors: T
authors: Abuya
authors: R
authors: R
authors: Wahlström
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D007630:Kenya; D055118:Medication Adherence; D036301:Qualitative Research
chemical_list: D044966:Anti-Retroviral Agents