Summary

Program goals

The objectives of the five-year initiative ART program are: - Develop and validate a set of indicators that can be used to monitor adherence to ART - Investigate adherence rates and determinants for these rates for ART programs and individuals in two target countries - Pilot interventions to improve adherence in individual patients and in programs in two countries - Establish the process needed for national AIDS control programs to scale-up successful interventions as part of national policy in the two countries - Work with the other three countries in the region to develop national adherence policies and implement interventions to improve adherence

Key program components

Many countries received international funding to scale up antiretroviral therapy (ART) programs, but there is a lack of practical approaches to monitor patients adherence. If the adherence rate is less than 90-95 percent, treatment can fail, and the human immunodeficiency virus may become resistant to medicines. Therefore, the ability to accurately monitor treatment adherence and address problems immediately is crucial to the success of ART. INDRUD-IAA is working to improve Adherence to Antiretroviral Treatment in East Africa both in the facilities level and individual levels. Because taking medicine is a private affair, all individual-level adherence measurements are indirect. The program looks at the possible ways to use standardized methods to collect data and to measure important aspects of patient treatment adherence and clinic attendance in a wide variety of health facilities in resource-poor settings. Using results from previously conducted surveys, along with measurement approaches described in the adherence literature, INRUD-IAA collaborators defined a draft set of core indicators for monitoring adherence and attendance that could be calculated from data routinely available in ARV treatment clinics. The program then developed standardized methods to collect data and calculate the indicators. Using these simple, low-cost methods to identify poorly performing facilities enables ART program managers to examine the causes of poor performance and work with facilities to make improvements.

The International Network for the Rational Use of Drugs Initiative on Adherence to Antiretrovirals’s (INRUD-IAA) previous study of 24 systems of care providing antiretroviral (ARV) medicines in Ethiopia, Kenya, Rwanda, Tanzania, and Uganda showed that practices in monitoring rates of antiretroviral treatment adherence and defaulting were inconsistent. Stakeholders recommended standardizing methods to monitor and measure adherence and defaulting and developed a series of indicators and potential determinants to test. In 2006, the International Network for the Rational Use of Drugs Initiative on Adherence to Antiretrovirals (INRUD-IAA), in collaboration with the national AIDS control programs from Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, carried out a survey that assessed how existing ART programs and health care facilities tracked patient adherence and treatment defaulting. ART programs had started in Uganda as early as 1991, in Rwanda 1999, Kenya 2001, Ethiopia 2003 and Tanzania 2004. However, the survey showed that many programs and facilities had no processes in place to measure treatment adherence or defaulting at either the patient or program level, and among those facilities that did conduct measurements, definitions and data collection practices varied widely, although they routinely collected useful data.