From Access to Adherence: The Challenges of Antiretroviral Treatment - Studies from Botswana, Tanzania and Uganda, 2006
(2006; 320 pages) View the PDF document
Table of Contents
View the documentAcknowledgments
View the documentAcronyms and abbreviations
View the documentForeword
Open this folder and view contents1. On hunger, transport costs and waiting time: a synthesis of challenges to ARV adherence in three African countries
Open this folder and view contents2. Overview of antiretroviral therapy, adherence and drug-resistance
Open this folder and view contents3. From training to action: the process of engaging health professionals in operational research on adherence to antiretroviral therapy
View the document4. There's hope - early observations of ARV treatment roll-out in South Africa
Close this folderFactors that facilitate or constrain adherence to antiretroviral therapy among adults at four public health facilities in Botswana: a pre-intervention study
View the documentAcknowledgements
View the documentAcronyms and abbreviations
View the documentExecutive summary
Open this folder and view contentsChapter 1: Introduction
Open this folder and view contentsChapter 2: Background
Open this folder and view contentsChapter 3: Methodology
Open this folder and view contentsChapter 4: Quantitative results
Open this folder and view contentsChapter 5: Qualitative results
Open this folder and view contentsChapter 6: Discussion, conclusion and recommendations
View the documentReferences
View the documentAnnex 1: Mean of rates adherence
View the documentAnnex 2: Multivariate logistic regression analyses on the predictor variables
View the documentAnnex 3: Questionnaires
Open this folder and view contentsA study on antiretroviral adherence in Tanzania: a pre-intervention perspective, 2005
Open this folder and view contentsFactors that facilitate or constrain adherence to antiretroviral therapy among adults in Uganda: a pre-intervention study
View the documentBack cover
 

Annex 3: Questionnaires

1. Focus group discussion (FGD) for antiretroviral users: Questionnaire

• Participants per FGD (6-8)

• Adults (= or >18 years, men and women separately - may want also to split into high- and low-adherers, if easily identifiable, depending on what country teams want to do)

• One moderator, one note-taker (and use of tape recorder)

• Neutral venue outside the facility

• Two FGD per facility (one with men and one with women)


Short introductory remarks

• Introduction of researchers and participants

• Thank participants for agreeing to participate, all share a common feature - they are on ARV treatment, are here to share their thoughts about ARVs and difficulties in taking ARVs: we want to learn from participants

• Explain purpose of study, purpose of this discussion, reassurance about confidentiality, agree on rules.


Topics for discussion

1. What treatments do you know to be available for treating HIV? What is your opinion about these? (e.g. ARVs; herbs; traditional medicines; spiritual healing; prayers; and perceived benefit (s) of treatment).

2. What is your experience of ART? (probe about adherence, adverse effects, pill burden, lack of food, lifestyle issues).

3. How do you think you are being treated (handled) by the health care workers (probe: privacy, confidentiality, respect, being listened to, time spent with patient, waiting time, integration with other services). What is the quality of care provided by health care workers?

4. What do you think about the counselling that you receive? (probe especially on importance of adherence effectiveness of counselling). What support are you given by the health workers to help you adhere better to your medications? Have you disclosed?

5. What support is available for you in the community, in the family, in the workplace? (probe about discrimination, stigma). Probe differences in perceived availability of social support versus social networks? Any negative social support? Any stress exacerbation?

6. What do you think could be done to help people adhere more easily to their treatment?

7. What do you think are the key reasons for non-adherence and good adherence? What are the sources of motivation for adherence?

8. Duration of discussion (IV2 hours); provide refreshments

9. Conclusion, thank participants

2. Focus group discussion for community members: Questionnaire

1. Explore the role of participants in HIV/AIDS. Explore whether the members know about ARVs; what it is and the current practice of service delivery in ARV use. Explore where people obtain medicines for HIV/AIDS (ARVs) in the area. Assess accessibility to information on ARV.

2. What are the perceptions/beliefs/attitudes of the community on HIV/AIDS, treatment modalities? What are the perceptions of the community on current criteria for inclusion in ARV treatment? Probe for reasons for perceptions. What criteria should be used for starting antiretroviral therapy?

3. How easy/accessible is it for people in your community for people who are taking ARVs? (Probe on stigma, discrimination, logistical issues for reaching the clinic etc.)

4. Can existing infrastructure be modified and strengthened to adapt to antiretroviral provision? What resources are needed to make antiretroviral widely available in your area?

5. In your view, what are the current barriers to adherence for the individuals living with HIV in your community?

a) Demography (age, sex, ethnicity/language, socioeconomic status)
b) Information (knowledge, self efficacy, coping, etc)
c) Motivation (beliefs, depression, drug use)
d) Behaviour skills (pill taking, scheduling)
e) Provider - expertise, trust
f) Regimen - simplicity, toxicity, disruption of daily activities
g) Disease stage
h) Clinical setting


Probe on how cultural, psychological behavioural and contextual circumstances influence adherence?

6. Solutions: In your view, how can adherence be enhanced in your community? What activities take place at the moment in your community to help people adhere to their medication? (Probe on support, HBC, individual coping capacity. Probe on existing strategies to improve adherence.). How can therapeutic effectiveness, adverse side-effects, and the emergence of drug resistance be monitored?

What should be done to assist people on ARVs to take their medications as instructed?

7. Are there barriers/obstacles different in different health care systems for primary care centres as in private practice? How can the situation be improved?

3. Semi-structured interview with health care workers

Guidelines for semi-structured interviews with health workers
(to be adapted for use with different type of health workers - medical doctors, nurses, counsellors, pharmacists, social workers)

Name of facility:

______________________________________________________

Name interviewer:

______________________________________________________

Interview number:

______________________________________________________

Date:

______________________________________________________

(Introduction of the interviewer (s), introduction of the study)

Background information on informant (health worker)

a) Sex

M/F

b) Age

_________ years

c) Profession

 

e) Role in ARV programme

 

f) Involved in programme since....

 

Tasks and training

a) What specific training have you received for this job in relation to ARV programme? Tell me about the training (Details)

b) Do you think this training has been sufficient? (Details)


Drugs, treatment and procedures

a) Which treatment guidelines for HIV/AIDS management do you use at this facility? (Give details if necessary, e.g. national guidelines etc)

b) Are the drugs you prescribe always available? (If not, give details - how often, reason, what do you do about it)

c) Are the drugs in the guidelines you use to dispense always available? (Give details - how often, reason, what do you do about it)

d) Have you had periods where your patients have not been able to get their medications because they were not available in stock?

e) How reliable are your lab and diagnostic support services? Do results come in on time? Details.

f) What is your procedure when a patient is put on ARV drugs for the first time?

g) What is your procedure when a patient switches regimens?

h) In what ways are ARV-users informed about and prepared for ARV treatment?

i) What kind of information do they receive? Please describe it to us:


   

• The disease process (i.e. HIV and AIDS)

   

• How the disease affects the body

   

• How ARVs work

   

• How to use them

   

• The need to continue treatment

   

• What to do if a pill is forgotten

   

• Possible interactions with other drugs

 
   

(including traditional medicines)

   

• Which side effects can occur & what to do if they occur

   

• (Breast) feeding requirements

   

• When and where to get re-supply

 

Who is giving this information?


Adherence issues

a) Generally speaking, do your patients keep their appointments?

b) How do you think your patients do, generally speaking, in terms of adherence to ART?

c) Could you estimate the percentage of your patients who you think are "sufficiently adherent" to ART? (Respondent gives their definition of 'sufficiently adherent' what level is that?) **

d) What do you use to determine adherence (probe: appointments, refills?)

e) We would like to get your views on the following (probe): From your experience

• How would you compare adherence between women and men?
• How would you compare adherence between older patients and younger patients?
• How does a patient's educational level affect adherence?
• How do you think that cost to patients influences adherence?


f) How do you think the distance to the health facility affects adherence?

g) From your experience how do you think the following affect adherence?

• Having or not having a treatment-support partner?
• Duration of treatment?
• Side effects?
• Lack of food?
• Knowledge about ART?


h) What strategies are in place to monitor adherence?

i) What strategies are in place to support adherence? (probe: family/community involvement).

j) What are the main challenges you face in supporting your patients to adhere to ARV drugs (especially for longer term users)?


Challenges and staff support

a) What are the main challenges you and your colleagues face more generally in your work? (if necessary, prompt re workload, stress, burnout)

b) Have you ever been afraid of being infected with HIV through your work? What were you specifically afraid about? How do you feel now about the HIV- infection risks? Do you take any extra precautions when working with them?

c) Have these challenges changed in any way since you started working at the ARV clinic?

d) Is any special support made available for staff engaged in management of HIV/AIDS at this facility? If no, do you think there is a need to have such support?

e) Is there anything you would like to see done differently in this facility? If yes, what?


Is there anything else you would like to tell us or ask us?

Thank you very much for your participation in this interview.

4. Semi-structured interview with ARV users

Name of the interviewer:

______________________

Interview number:

______________________

Name of health facility where patient contacted:

______________________

Date:

______________________

NB:

• Informed consent
• ARV-user will be contacted initially at the health facility, but the interview will be conducted at another time and place.


Introduction of the interview, introduction of the study, consent requested with option not to participate. Statement of confidentiality.

Sociodemographic information on informants

a) Sex

M/F

b) Age

______ Years

c) Educational level

 

d) Who do you live with? (spouse, children, mother etc.)

 

e) What do you do for a living

 

f) Distance from facility (in time or distance)

 

Medical history of patient

a) When were you first diagnosed with HIV?

b) What made you decide to go for testing?

c) When did you start treatment for HIV (ARVs)?

d) How do you feel about your health since you started treatment?

e) How would you describe your health since you started treatment?

• Better
• Same
• Worse


Patient knowledge about HIV/AIDS

We would like to understand what people actually know about the illness that they have. Can you tell me what you know about HIV/AIDS? (Allow patient to say what they want, then probe on the following: cause of HIV infection, cause of AIDS, prevention, life-long infection).

Apart from this, is there anything else you may have heard from your community that explains AIDS in a different way?

Patient knowledge about ARVs

We would like to understand what people know about HIV/AIDS medicines. Could you help us with this by telling me what you know about ARVs? (Allow patient to say what they want, then probe on the following: prolongs life, improves quality of life, life long treatment, knowledge about side effects).

Assessment of adherence and non-adherence

We are trying to find out how patients manage to take their medicines - for some people it's not a problem, but we also know that others don't always find it easy. Please feel free to be open about the problems you face with this. Everything you say here will remain confidential, and will not be shared with anyone at the clinic.

a) Do you have your medicines with you? May I see them? Please can you tell me when you take each of the medicines?

b) Are there any other medications you are taking (e.g. traditional medicines, herbs, medicines from other hospitals, clinics, shops/chemist, etc.)

c) Over the last two days, when did you take your pills? (Not including today - starting from last night and back.) (Complete 'sun-and-moon chart', or other checklist)

d) Did you perhaps miss any? (Confirming (c), sympathetic manner. Details if yes.)

e) This is a very important question. We appreciate how difficult it can be to take pills on a daily basis. If you sometimes miss a dose, please can you tell me what causes this to happen? Can you give an example or two? (Include even if 'simply forgot').

f) On the other hand, what is it that helps you to take your pills regularly and on time? (e.g. buddy, relatives, individuals, cell-phone, clock etc.)

g) Have you disclosed your status to any one? If so, who? Do they help you to take your pills? [If not covered in (f)]

h) Have you had your treatment changed at any moment since you were started on ARVs? If yes, why? (e.g. treatment failure, side-effects, drug not available).

i) Have you ever missed an appointment at your IDCC? (Reasons, and details on type of consultation: review/refill, counselling etc.)

j) What do you think happens in your body if you skip your ARV medicines?

k) Have you ever thought about stopping HIV/AIDS medicines (ARVs)? If yes, details.


Perception about HIV/AIDS, ARVs and stigma

Have you ever had any experience of being treated differently because of your HIV status? (in your family, at work, at the church etc)

Cost considerations

a) How much do you have to pay to cover your travel expenses when you visit the clinic?

b) What is the cost of registering at the clinic (if any)?

c) What is the cost of the ARV medicines that you take (if any)?

d) Do you lose any income as a result of your coming to the clinic?

e) Do you incur any other costs as a result of your taking ARVs?

f) What have you and/or your family had to give up in order to be able to take your medicines regularly?


Quality of care

(a) What do you think of the service you receive at this clinic? (General, open- ended, and then prompt, as below: ask for details as necessary)

• Do you feel listened to?

Yes

No

• Are you given the chance to state your problems and ask questions?

 

Yes

No

• Are you treated with respect?

Yes

No

• Do you feel you can trust the health workers?

Yes

No

• Do you have privacy during consultation and counselling?

   
 

Yes

No

• How do you find the environment of the clinic?

_____________________________________________________________

(b) How long did you spend altogether at the clinic when you last went for review?

(c) How long did you have to wait before being attended to?

___________________________________________________________________

Perceived problems and possible solutions

a) What do you perceive as the biggest problem regarding taking ARV treatment?

b) What do you think could be done to improve this?

Do you have any questions for me?

Thank you for your time and co-operation!

5. Adherence measurement tool for antiretroviral users: Questionnaire

6. Exit interviews with ARV users

Guideline for exit interviews with PLWHIV using ARVs

(To be conducted after pharmacy visit, i.e. when all their business at the health facility is completed).

Name of facility

________________________________

Name of interviewer

________________________________

Interview number

________________________________

Date

________________________________

(Introduction of the interviewer (s), introduction of the study, consent requested with option not to participate, assurance of confidentiality)

Background information on informant

a) Sex

M/F

b) Age

_____ Years

c) Educational level

 

d) What do you do for a living

 

e) Distance from facility (in time or distance) (NB village or ward)

 

Whom did you visit today? (Can include more than one)

• Counsellor
• Nurse
• Medical doctor
• Pharmacist
• Other
___________________________________________


What was the reason for your visit today?

• Counselling
• To start using ARV/AIDS medicines
• Routine follow-up, if yes: when did you start using the AIDS medicines?
• Other reason:


What was the result of the visit?

• I got ARV medicines for the first time
• They gave me a refill of my ARV medicines
• They gave me a different kind of ARV medicines
• If yes, why did the doctor prescribe different medicines?
___________________________________________________________
• Other
___________________________________________________________


If you were given AIDS medicines for the first time today, or were given a new kind of AIDS medicine today, what did the health worker tell you? (Open ended, then probe on following topics)

What HIV/AIDS is?

By whom?

How ARVs work?

By whom?

How to use them?

By whom?

The need to continue treatment

By whom?

What to do if a pill is forgotten

By whom?

Possible interactions with other drugs

By whom?

(including traditional medicine)

 

Which side effects can occur with (state the drugs the patient is taking) & what to do if they occur

By whom?

(Breast) feeding requirements

By whom?

When and where to get re-supply

By whom?

What is required when you come for re-supply (bring unused medicines?)

By whom?

(If client was given a repeat prescription, ask him/her the following; if new patient, proceed to 8)

What did you discuss with the health worker?

______________________________________________________


Probe for:

a) Did you talk with the health worker about your experience of using your medicines? (Side effects, perceived effects)

• Did the health worker ask you if you have missed a dose?

 

Yes

No

b) If yes, did the health worker explain what the effects are of missing a dose?

 

Yes

No

c) Did your health worker count your pills before giving you a new supply?

 

Yes

No

d) Did the health worker ask you if you were taking any other medicines?

 

Yes

No

Assessment of adherence and non-adherence

a) Do you have your medicines with you?

 

Yes

No

b) May I see them? Please can you tell me when you take each of the medicines?
(Refer to table with sun and moon, or other checklist)

c) Are there any other medications you are taking
(e.g. cotrimoxazole, traditional medicines, herbs etc)

 

Yes

No

d) Over the last two days, when did you take your pills? (Not including today from yesterday evening and back.)

e) Did you perhaps miss any?
(Confirming (c), sympathetic manner. Details if yes.)
__________________________________________________

f) What do you do to remind yourself to take your pills?
__________________________________________________

Cost consideration

a) How much do you have to pay to cover your travel expenses when you visit the clinic?

b) Do you lose any income as a result of your coming to the clinic?

 

Yes

No

c) (Do you incur any other costs as a result of your taking ART?

 

Yes

No

d) Do you and your family have to give anything up in order to be able to pay for your ART?

 

Yes

No

Quality of care in the ARV Clinic

I would like to ask you some more questions about the way you were treated in the clinic today.

a) What do you think of the service you receive at this clinic? (General, open- ended, and then prompt, as below: ask for details as necessary)

Do you feel listened to?

Yes

No

Are you given the chance to state your problems and ask questions?

Yes

No

Are you treated with respect?

Yes

No

Do you feel you can trust the health workers?

Yes

No

Do you have privacy during consultation and counselling?

Yes

No

How do you find the environment of the clinic?

Yes

No

b) How long have you spent altogether at the clinic today?

______________________________________________________

c) How long did you have to wait before being attended to?

(For consultation

min/hours

For dispensing

min/hrs

d) Did you receive any written information?

Yes

No

Perceived problems and possible solutions

a) What do you perceive as most problematic regarding taking the ARV treatment?

b) What do you think could be done to improve this?

Anything else to say or ask?

Is there anything else you would like to tell us or ask us?

Thank you very much for your participation in this interview.

7. Guide for observation of health facility

Name of observer

_______________________________

Name of health facility

_______________________________

Date/time observation took place

_______________________________

This observation shall be conducted by the researchers.

The purpose is to give a descriptive of the setting under which care takes place.

1. Describe hospital setting in general.

2. Describe the location and setting of the ARV clinic and support services (pharmacy, laboratory, social welfare/counselling).

3. Describe the sanitary condition of the environment, how clean or dirty is it, check out the toilets. Describe

4. Where are patients received? Is there privacy? Describe what you see

5. What is the general attitude of health workers, are they receptive and willing to assist clients or are they impatient? Describe what you see what notices or information are displayed for clients to read, describe

6. Specifically look through where patients get ARVs to see if there is any piece of information emphasizing the need for good adherence or telling people how to improve adherence.

8. Observation of consultation with health workers

Study no _______________________

(Medical doctor, Nurse, Pharmacist, Social worker/Counsellor, Receptionist, laboratory personnel).

Guide has to be adapted, taking into account the type of consultation to be observed

(Don'tforget informal, unstructured observations!!!)

Name of facility

________________________________

Date

________________________________

Interviewer

________________________________

Consultation:

Start time: ___________

End time: ___________

Observation of consultation with:...........................................................................................

Medical doctor
Nurse
Social worker/counsellor
Pharmaceutical staff
Receptionist
Laboratory personnel
Other:......................


1. Background information on informant

a) Sex

M/F

b) Age

........... Years (ask or estimate)

2. Reason/Aim of the consultation:

• Counselling
• Initiation of active ARV treatment
• Routine follow-up
• Other reason:...........................


3. Is patient well received?
(If not, describe)

Yes

No

___________________________________________________

4. Was the client greeted in a friendly manner?

Yes

No

5. Does the consultation take place in privacy?

Yes

No

6. Does the health worker ask about any symptoms?

Yes

No

7. Is the patient invited to ask questions?

Yes

No

(If yes, what do they ask? Was the question addressed?)

   

Details: _______________________________________________________

8. Is the patient told what to do next

Yes

No

(within the health facility)?

   

Is the patient told where to go for that?

Yes

No

9. Is the sequence of events in relation to treatment protocols explained to new patients? (Requires training for observer)

Yes

No

10a. If new patients, do they receive comprehensive general information about ARVs? (Tick if covered, X if not covered):

 

• How ARVs work

 

• How to use them

 

• The need to continue treatment

 

• What to do if a pill is forgotten/missed

 

• Possible interactions with other drugs, including traditional medicines

 

• Which side-effects (for the different drugs) may occur

 

• What to do if they occur

 

• (Breast) feeding requirements

 

• When and where to get re-supply

 

• Requirement to bring unused medicines

10b. Are patients (especially new and those switching regimens) given the following information about ARVs: (Tick if covered, X if not covered):

 

• Dosage (number of tablets to take and how often)

 

• Times of when to take the medicines

 

• How to take them in relation to meals (where necessary)

 

• What to do if vomit the pill

 

• What to do if forgets to take medicine on time

 

• What to do if dose is missed

 

• What to do if travelling?

10c. For follow-up users only:

Does the health worker ask if the patient missed a dose?

Yes

No

If yes, does the health worker explain the effects of missing dose?

Yes

No

Does the health worker offer support to not miss the doses?

Yes

No

If yes, describe
___________________________________________________________

11. Did the provider listen carefully to the client?

Yes

No

12. Was any written information given? (new patients)

Yes

No

If yes, bring a copy of it if possible.

   

13. For follow up patients only:

   

Does the health worker count the patient's pills before giving him/her a new supply?

Yes

No

14. Does the health worker ask the patient if they are taking any other medicines

Yes

No

15. Does the patient receive specific tools to remind them to take their medicines?

Yes

No

9. Semi-structured interview with site manager

Name of interviewer

______________________________

Place of interview

______________________________

Date of interview

______________________________

Officer interviewed

______________________________

Interviewer appropriately greets person to be interviewed, explains purpose of the interview.

The main purpose of these interviews shall be to ascertain to what extent adherence to medication was considered important prior to programme commencement.

• What strategies were put in place to encourage good adherence.
• What strategies were put in place to monitor adherence.
• What strategies are being put in place to improve adherence.


The interviewer shall probe where relevant - the questions below are merely a guide.

But we shall start with these questions.

1. When did the facility start providing ART?

2. Number of workers & type of staff involved in ART?

3. Number of staff trained & type of training?

4. Total number of patients on treatment at the facility?

5. Total number of patients seen per day?

6. Availability of reference materials, formularies etc.?

7. Criteria for eligibility to ART (documentary/verbal)?

8. We would like to know about the national roll out of ARVs, when and how did it all happen?

9. How was your office involved in it?

10. What in your opinion do you reckon to have been the greatest challenge you faced with the rollout?

11. How did you overcome the challenge?

12. What number of patients would you be looking at in the next one year by your projections?

13. Do you always receive your order as at and when due?

14. There had been times in the past when your patients had their ARV supply rationed because of inadequate stock, what do you know about this?

15. What mechanisms do you have to ensure availability and sustenance of ARV supply?

16. What do think the adherence levels of your patients' in terms of taking ARVs is?

17. What strategies have you in place to ensure patients receiving ARVs adhere well enough to their treatment?

18. Do you have any reporting and monitoring system for this?

19. Given your experience with your ARV programme is there any thing you would like to see done differently?

20. Do you think there are opportunities for improvement in your programme, if yes probe?

21. The Botswana rollout programme has drawn attention from all over the world, what do you think other countries contemplating national rollout for ARVs can learn from you?

Thank you very much for your time.

10. Questionnaire guideline for key informant interview List of possible key informants and topics

This is a guide to help researchers remember different issues that may be discussed with key informants of different types. They include general topics, which could be discussed with all these people; and additional topics as under each category. The list could be added to as new issues arise.

General topics

Handling of misconceptions about ARVs

Beliefs about illness (HIV)

Beliefs about ARVs/alternative ways of treatment

Community participation (pre-intervention sensitisation, communication channels, community response to sensitisation)

Community support system; Support systems for people living with HIV/AIDS: home-based care, compassionate visits (by whom, for what purposes)

Stigma/discrimination

Disclosure

Workplace

Employer support

Key informant categories

Member of council/Local Authority
Support systems for people on ARV treatment (transport, food baskets etc.)

Chief
Cultural support/discrimination

Religious leader
Spiritual support, prayers

Home-based care volunteers
Collecting medication
Administering medication
Pill counts at home

'Family Welfare Educators'
Education packages available
Follow up of non-adherent patients

Traditional healers
Handling of patients being treated with ARVs
"Referral" of patients

PLWHIV Association
Support systems
Stigma
Issues faced my members in relation to adherence, accessing drugs etc.

11. Semi-structured interview with national level policy makers

Name of interviewer

_______________________________

Place of interview

_______________________________

Date of interview

_______________________________

Officer interviewed

_______________________________

 

• Interviewer appropriately greets person to be interviewed, explains purpose of the interview.

• The main purpose of these interviews shall be to ascertain to what extent adherence to medication was considered important prior to programme commencement.

• What strategies were put in place to encourage good adherence.

• What strategies were put in place to monitor adherence.

• What strategies are being put in place to improve adherence.


The interviewer shall probe where relevant. The questions below are for guidance only.

We would like to know about the national roll-out of ARVs, when and how did it all happen?

a) How was your office involved in it?

b) What in your opinion do you reckon to have been the greatest challenge you faced with the rollout?

c) How did you overcome the challenge?


How many patients nationwide are on ARVs presently?

a) What number of patients would you be looking at in the next one year by your projections?

b) Where do you source your ARVs from?

c) Who does the procurement?

d) Do you always receive your order as at and when due?

e) There had been times in the past when your patients had their ARV supply rationed because of inadequate stock, what do you know about this?

f) What mechanisms do you have to ensure availability and sustainability of ARV supply?

What do think the adherence levels of your patients' in terms of taking ARVs is?

a) What strategies have you in place to ensure patients receiving ARVs adhere well enough to their treatment?

b) Do you have any reporting and monitoring system for this?


Given your experience with your ARV programme is there any thing you would like to see done differently?

a) Do you think there are opportunities for improvement in your programme, if yes probe?


The Botswana rollout programme has drawn attention from all over the world, what do you think other countries contemplating national rollout for ARVs can learn from you?

 

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