From Access to Adherence: The Challenges of Antiretroviral Treatment - Studies from Botswana, Tanzania and Uganda, 2006: A study on antiretroviral adherence in Tanzania: a pre-intervention perspective, 2005: Chapter 6: Discussion, conclusion and recommendations: 6.4 Proposed interventions

From Access to Adherence: The Challenges of Antiretroviral Treatment - Studies from Botswana, Tanzania and Uganda, 2006
(2006; 320 pages)

Table of Contents

Acknowledgments
Acronyms and abbreviations
Foreword
1. On hunger, transport costs and waiting time: a synthesis of challenges to ARV adherence in three African countries
	Introduction
	Methods
	Discussion
	Conclusion
	References
2. Overview of antiretroviral therapy, adherence and drug-resistance
	Background
	References
3. From training to action: the process of engaging health professionals in operational research on adherence to antiretroviral therapy
	Introduction
	Promoting the rational use of drugs
	Promoting Rational Drug Use in the Community course
	Three ARV adherence studies: the process
	How the process was funded
	Discussion and conclusion
	References
	Annex 1: PRDUC course participants by region, type of institution, sex and source of funding
	Annex 2: URLs for country proposals
	Annex 3: Call for proposals
4. There's hope - early observations of ARV treatment roll-out in South Africa
Factors that facilitate or constrain adherence to antiretroviral therapy among adults at four public health facilities in Botswana: a pre-intervention study
	Acknowledgements
	Acronyms and abbreviations
	Executive summary
	Chapter 1: Introduction
		1.1 Research problem
		1.2 Research questions
		1.3 Study objectives
	Chapter 2: Background
		2.1 History of HIV and AIDS in Botswana
		2.2 Botswana's ART programme
		2.3 Literature review
		2.4 Definition of concepts
	Chapter 3: Methodology
		3.1 Introduction
		3.2 Study design
		3.3 Study population
		3.4 Description of study sites
		3.5 Inclusion and exclusion criteria
		3.6 Selection and training of data collectors
		3.7 Qualitative data collection
		3.8 Observations
		3.9 Semi-structured interviews
		3.10 Exit interviews
		3.11 Focus group discussions
		3.12 Quantitative data
		3.13 Data analysis
		3.14 Emic perspective
		3.15 Ethical considerations
		3.16 Feedback
	Chapter 4: Quantitative results
		4.1 Adherence measurement tool results
		4.2 Rates of adherence to ARVs
		4.3 Reasons for skipping medication
		4.4 Factors affecting adherence to ART
		4.5 Predictors of adherence to ART
		4.6 Quantitative results of exit interviews
	Chapter 5: Qualitative results
		5.1 Constraints to adherence to ART
		5.2 Facilitators of adherence to ART
		5.3 Observation of health facilities 5.3.1 Structural issues
		5.4 National level policy issues
	Chapter 6: Discussion, conclusion and recommendations
		6.1 Discussion
		6.2 Conclusions
		6.3 Recommendations
	References
	Annex 1: Mean of rates adherence
	Annex 2: Multivariate logistic regression analyses on the predictor variables
	Annex 3: Questionnaires
A study on antiretroviral adherence in Tanzania: a pre-intervention perspective, 2005
	Acknowledgements
	Acronyms and abbreviations
	Executive summary
	Chapter 1: Introduction
		1.1 Background
		1.2 Rationale
		1.3 Literature review
		1.4 Problem statement
		1.5 Objectives
		1.6 Output
	Chapter 2: Methodology
		2.1 Study design
		2.2 Study population
		2.3 Inclusion and exclusion criteria for interviewees
		2.4 Quantitative data
		2.5 Qualitative data
		2.6 Data collection tools
		2.7 Pilot study
		2.8 Sample size and sampling strategy
		2.9 Data collection
		2.10 Ethics
	Chapter 3: Study areas
		3.1 Health care facilities
	Chapter 4: Quantitative results
		4.1 Demographic characteristics of ARV users
		4.2 Adherence rates
	Chapter 5: Qualitative results
		5.1 Factors that influence adherence to ARVs from the users' perspective
		5.2 Quality of operating structures
		5.3 Opinions and suggestions given by respondents to improve provision of ARVs
	Chapter 6: Discussion, conclusion and recommendations
		6.1 Discussion
		6.2 Conclusion
		6.3 Recommendations
		6.4 Proposed interventions
	References
	Annex 1: Exit interview with ARV users
	Annex 2: Semi-structured interview with ARV users
	Annex 3: ARV users, FGDs
	Annex 4: Adherence measurement tools
	Annex 5: Key informant interview
	Annex 6: Semi-structured interviews (with staff)
	Annex 7: Observation (consultations)
	Annex 8: Observation of antiretroviral
Factors that facilitate or constrain adherence to antiretroviral therapy among adults in Uganda: a pre-intervention study
	Acknowledgements
	Glossary
	Executive summary
	Chapter 1: Introduction
		1.1 Background
		1.2 Research problem
		1.3 Research objective
	Chapter 2: Background to the study
		2.1 History of AIDS in Uganda
		2.2 History of ARVs in Uganda
	Chapter 3: Literature review
		3.1 Importance of adherence to ART
		3.2 Measurement of adherence
		3.3 Factors affecting adherence to ART
		3.4 Impact of the drug regimen on adherence
		3.5 Treatment characteristics affecting adherence 3.5.1 Physical state and disease stage
		3.6 The clinic setting and service provision
		3.7 Simplifying treatment regimes to improve adherence
		3.8 Conceptual framework
	Chapter 4: Methodology
		4.1 Study design
		4.2 Study population
		4.3 Inclusion and exclusion criteria
		4.4 Sample size and selection
		4.5 Data collector selection and training
		4.6 Pilot testing
		4.7 Data collection
		4.8 Data analysis
		4.9 Evaluation of methods
		4.10 Ethical considerations
	Chapter 5: Description of the study sites
		5.1 Jinja Regional Referral Hospital
		5.2 Nile Treatment Centre
		5.3 Study limitations
	Chapter 6: Results
		6.1 Demographic characteristics of ARV users
		6.2 Factors influencing adherence to ART
	Chapter 7: Discussion, conclusions and recommendations
		7.1 Discussion
		7.2 Conclusions
		7.3 Recommendations
	References
Back cover

6.4 Proposed interventions

The following are the proposed interventions from this study.

INTERVENTION	SPECIFIC TARGET	METHOD OF EVALUATION	EXPECTED IMPACT
Managerial	Institute pill counting.	No. of clients bringing pills for counting.	Improve adherence rate.
	Employ adequate numbers of staff.	No. of new staff employed.	Reduce waiting time and improve counselling.
	Ensure reliable supply of medicines.	Availability of reliable medicine supply chain.	Improve adherence rate.
	Increase the no. of ART clinics.	No. of new ART clinics.	Reduce workload in ART clinics.
	Facilitate the transfer of ARV users to ART clinics closer to home.	No. of users transferred to ART clinics closer to home.	Improve adherence rate.
	Open clinics early and minimize waiting time.	No. of clinics open on time.	Reduce waiting times.
	Provide rooms for consultation that offer greater patient confidentiality.	No. of clinics with consultation rooms that offer patient confidentiality.	Improve attendance and adherence rate.
Educational: Training of provider	Update knowledge of staff.	System to update staff knowledge in place.	Improve adherence rate.
	Train staff in adherence counselling (emphasize initial side-effects).	No. of staff trained in adherence counselling.	Improve adherence rate.
	Train staff to be supportive, in an effort to minimize stigma.	No. of supportive staff trained.	Reduce stigma.
Educational: Training of the public	Train community counsellors who operate from home (as seen in Arusha).	No. of community counsellors trained.	Improve adherence rate.
	Prepare IEC materials focusing on promoting disclosure and reducing stigma.	No. and types of IEC materials prepared.	Increase disclosure rate and reduce stigma.
	HIV-related education for the public through radio, TV and newspapers.	No. of programmes produced.	Increase disclosure rate and reduce stigma.