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INRUD-IAA Working to Improve Adherence to Antiretroviral Treatment in East Africa

Patient in Nairobi, Kenya

Although many countries are scaling-up antiretroviral therapy (ART) programs, no one has developed any practical approaches to monitor how well patients adhere to their treatment. Accepted wisdom is that if the ART 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. The International Network for the Rational Use of Drugs Initiative on Adherence to Antiretrovirals (INRUD-IAA) is taking on the challenge.

A Snapshot of ART Adherence Tracking in Five Countries

In a 2006 assessment of how ART programs were tracking patient adherence in Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, results found that facilities routinely gathered useful information that could be used to monitor adherence and treatment defaulting, but the ways facilities gathered and analyzed data varied: Only 20 of 48 facilities routinely measured individual patient adherence levels, and only 12 measured overall adherence for their clinic population. Fourteen different definitions of treatment default were in use—ranging from one day to six months following a missed appointment. In a follow-up meeting, stakeholders agreed on the need to standardize definitions of adherence and defaulting and define standard indicators to help identify patients at risk and monitor ART program performance. The measurement method would need to be practical, affordable, reproducible in any setting, and produce reliable results. >> Read More

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