Here are the key points from HATIP 176 on antiretroviral adherence. These are important points for all ART providers. The document is attached.
What methods are used in Myanmar to 'trace defaulters'?
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• Adherence to treatment and retention in care are important challenges for all HIV treatment programmes, especially where resources are limited.
• Retention in care after one year in many treatment programmes in sub-Saharan Africa is 60%, indicating that a lot of patients are being lost and a lot of time and money is being wasted preparing patients for treatment and treating them for a few months. Much less time and money is being invested in finding these patients once they fail to return to the clinic.
• More attention need to be given to finding the patients who don’t return to the clinic, and finding the most cost-effective methods for doing so.
• At present defining a gold standard for adherence measurement tools is difficult; there are many tools and each has its advantages and disadvantages.
• Clinics that can dedicate more staff time to tracing defaulters, and going out into the community to do so, may have lower rates of loss to follow-up.
• The longer that a clinic leaves it to follow up a missing patient, the more likely they are to be permanently lost to follow-up.
• Retention of patients not yet on ART is important; patients lost to follow up before they are eligible for treatment could become late presenters who only turn up when seriously ill.
• Offering cotrimoxazole prophylaxis may improve retention in care for those not yet eligible for ART.
• ART preparedness counselling requirements may be onerous, and further work is needed to examine whether they are responsible for the disappearance of patients.
• Fast-tracking of patients of patients at high risk of serious AIDS-related illness should be a priority.
• Among those already on treatment, younger adults may need special attention to prevent loss to follow-up.
• Support groups and pill counts were associated with better adherence in a Nigerian study, but it may be the feeling of accountability of the patient to the health care worker, rather than the monitoring effect of spotting missed
