ARV adherence country studies : commonalities and differences 1) Objectives 2) Sampling frames 3) Methodologies

1. ARV adherence country studies:commonalitiesand differences 1) Objectives2) Sampling frames3) Methodologies

2. 1) Objectives • Uganda: to analyse factors leading to non-adherence to ARVs in selected government and non-government sites in Uganda. • Tanzania: to identify possible factors and operational barriers contributing to non-adherence for ARV treatment among HIV/AIDS patients and possible ways for improving the adherence in Tanzania. • Botswana: to determine the factors which influence adherence to antiretroviral therapy in patients receiving HAART from the public sector in Botswana. • South Africa: to identify factors that contribute to adherence and non-adherence to ART among HIV/AIDS patients, and to identify ways to enhance treatment.

3. Key commonalities and differences • All four countries are focusing on the factors that affect adherence and/or non-adherence • Ug and TZ are looking at non-adherence, Botswana at adherence, SA at both adherence and non-adherence – how different are these approaches? • All four countries are looking at both client/community level and facility level

4. All four countries intend to produce specific recommendations for interventions to improve adherence • Botswana is looking at factors associated explicitly with high-, moderate- and low-adherers • Botswana has an additional focus on national level (policy) issues

5. Apart from the reference to counselling by South Africa, none of the studies are looking at adherence to prevention practices within the context of ART • Tanzania is assessing the quality of operating structures for provision of ARVs

6. 2) Sampling frames • Facilities • Individual participants: clients, health workers, community etc

9. Key commonalities and differences • Facility-level: different numbers, different types and different sampling approaches in all countries • Individual participant level: Sampling frames/approaches for the individuals who will take part in studies remain relatively undeveloped by all countries

10. Sampling methods are not consistently systematic in any of the country proposals. • Quantitative data in particular may therefore be biased: reduced capacity to generalise from findings

11. All countries are choosing to work over a wide (ambitious?) geographical area. • South Africa also includes patients who have not yet started taking ART, in order to investigate the pre-treatment counselling process

12. 3) Methodologies

13. Key commonalities and differences • All countries plan to use both qualitative and quantitative methods, explicitly for purposes of triangulation • Main methodological techniques for all countries are identical

14. All countries are looking at both facility and client/community levels • None of the countries are making use of patient diaries

15. Tanzania is proposing home visits for data collection – feasibility and ethics? • Tanzania is stratifying at facility level by those that offer home-based care and those that do not

16. South Africa’s approach is more quantitative than the others • The bulk of the Uganda data will be based on qualitative methodologies; usefulness of KAP study?

17. Botswana is the only country looking at the policy level (even if that’s not a purely methodological issue) • Botswana has outlined some specific hypotheses to be tested • Botswana plans to use the qualitative data, in part, ‘to form the basis for generating a survey instrument (questionnaire).’