MAKERERE - UGANDA

Adherence to anti-retroviral treatment (ART) in Uganda.

There are about a million people infected with HIV, of whom 150,000 are clinically eligible for antiretroviral therapy (ART). But only 80,000 are now on ART provided by different programmes based on various models. On the other hand, as constraints to wide-scale access to ART progressively reduce, a scale-up plan of increasing ART access in the country is underway. However, there is no information on how the adherence to ART treatment varies across these divergent outlets in the country. These modes of delivery, including the one from the Ministry of Health, and the extent to which they address ART treatment adherence, HIV prevention, monitoring and evaluation are not well documented. The goal of this study is to identify feasible and replicable methods of improving adherence to antiretroviral therapy for use in the context of resource limited settings. This will be achieved over three phases. This initial study examined current practices of adherence measurement, recording, reporting and adherence support interventions. A cross sectional survey of 32 sites in 19 districts was conducted. From these 32 sites 16 were purposely selected to include a range of both typical and unique approaches to adherence support. Site and adherence support programme characteristics were assessed in more detail by the research team by face-to-face interview with the clinical lead.

This showed that measurement, recording and reporting of adherence were not consistent, showing both inter- and intra-site variations. Correlation between staff and patient reported and documented levels of monitoring was sub-optimal in most study sites. The majority aimed to monitor adherence by pill-count only. Mechanisms for assessing patient adherence were variable with some sites allowing verbal reports from patients. Mechanisms of reporting based on pill count results ranged from approximations to recording the exact number of pills left. The periodicity of reporting (monthly) corresponds with a central drug stock out which negatively impacted on dispensing practices as tablets had to be dispensed on a weekly basis. From the findings of the study, strengthening of local recording and reporting procedures to improve ART adherence was made in the 8 study districts. This study has been paramount in informing nationwide practice for policy measures.