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Methodological Aspects of the Study :

This study examines baseline data and predictors of adherence in antiretroviral therapy patients at Maun General Hospital in Botswana. It covers various adherence measurement methods, challenges, and concludes with recommendations for standardized adherence monitoring and healthcare facility interventions.

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Methodological Aspects of the Study :

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  1. Methodological Aspects of the Study: Baseline Data and Predictors of Adherence in Patients on Antiretroviral Therapy in Maun General Hospital [MGH], Maun, Botswana

  2. Background Info • ACHAP. National antiretroviral program • No experience/Baseline data on Adherence [Weiser et al pre roll-out study] • Pre-treatment Antiretroviral Adherence Counseling, PADAC as part of protocol • Integrated Patient Management Systems, IPMS. • Our study found 83% average adherence

  3. Measuring Adherence 1 • Pill Count Method. -The use of Adherent days/Month -The use of Zero tolerance to Non-adherence -The place of overage & extra pills in measurement -MGH methodology -How to calculate average adherence for HAART

  4. 7 days recalls questionnaire • -Subjective • -Standard questions memorized, used with probes [hybrid of 7 days recall & Provider assessment] • -Values assigned in percent based on provider estimation • -Found useful even in experienced patients to clarify suspected non-adherent days Measuring Adherence 2

  5. Measuring Adherence 3 • Pills Identification tests -Challenges include how you value PIT patient performance -Useful at the early days of therapy • Monthly Pill Calendar -Highly subject to fabrications -Also utilizes zero tolerance to non-adherence

  6. Challenges • Subjective nature of adherence reports • Non-electronic methods and their susceptibility to fabrications • Grading of adherence scores particularly with 7 days recall and provider assessments • Even conflicting reporting of observations from Pill counts • Time consuming

  7. Conclusions • Simple and non-electronic adherence measurement methods should be standardized as they are crucial in developing countries • There is a need to evaluate the efficacy of formal institution-based comprehensive adherence education and counseling programs and other interventions • Healthcare facilities should develop adherence monitoring and measurement plans that is ongoing and multidisciplinary • MGH Manual and methodology could do with experiences from other treatment centers.

  8. ADHERENCE MONITORING • -A Manual/SOP for Healthcare Providers for the Provision of Adherence Support for Individuals on Antiretroviral Therapy Prepare By Jude Nwokike [B.Pharm.,MSc.Pharmacology] Principal Pharmacist 11, Maun General Hospital, Maun. Rep. of Botswana.

  9. Thank You!

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