HIV/AIDS treatment adherence monitoring and promotion policies and practices in East Africa

Issues In developing countries, optimum adherence to antiretroviral therapy (ART) faces barriers posed by patient and regimen-related factors. Two partner organizations surveyed health care providers in East Africa to compare current policies and practices in measuring adherence levels and default rates among patients on ART, as well as to analyze the interventions used, planned, or recommended to improve adherence to ART.

Description The major HIV/AIDS treatment programs (government or nongovernmental) were identified in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania. The organizations interviewed program managers (24) regarding policies and staff members from one central and one peripheral facility from each system (48) serving 86,807 ART patients.

Lessons learned The findings showed that adherence monitoring policies are lacking and that practices are haphazard among ART clinics and pharmacies. Only 20 of 48 facilities routinely measured individual adherence levels; only 12 aggregated rates of adherence for the clinic population. Fourteen different definitions of defaulting ranged from 1 day to 6 months following a missed appointment. Respondents recommended different approaches to improving adherence in their facilities based on their perceptions of local challenges.

Recommendations Internationally harmonizing the policy regarding operational definitions and methods to measure treatment adherence is key to effectively monitoring scaling-up ART programs. Survey results suggest that ART providers understand the complexity of adherence promotion and have different ideas about how best to address obstacles to adherence in their patients; providers were willing to cooperate with local organizations to improve the levels of adherence, which would maximize resources.