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Monitoring Adherence and Defaulting for Antiretroviral Therapy in 5 East African Countries: An Urgent Need for Standards

Center for Pharmaceutical Management, Management Sciences for Health, Arlington, Virginia, jchalker{at}msh.org

Tenaw Andualem, BPharm, BA, MSc

Department of Pharmacology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia

Omary Minzi, MPharm, MPharm Sci, PhD

Department of Pharmacy, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania

Joseph Ntaganira, MD, MPH, DTM

Department of Epidemiology and Biostatistics, School of Public Health, National University of Rwanda, Rwanda

Atieno Ojoo, BPharm, MPH

Kenyatta National Hospital, Nairobi, Kenya

Paul Waako, MBChB, MSc, PhD

Department of Pharmacology and Therapeutics, Makerere University Medical School, Kampala, Uganda

Dennis Ross-Degnan, ScD

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts

Objectives: A cross-sectional survey was performed in 24 systems of care providing antiretroviral medications in Ethiopia, Kenya, Rwanda, Tanzania, and Uganda to examine current practices in monitoring rates of treatment adherence and defaulting.

Results: Only 20 of 48 facilities reported routinely measuring individual patient adherence levels; only 12 measured rates of adherence for the clinic population. The rules for determining which patients were included in the calculation of rates were unclear. Fourteen different definitions of treatment defaulting were in use. Facilities routinely gather potentially useful data, but the frequency of doing so varied widely.

Conclusions: Individual and program treatment adherence and defaulting are not routinely monitored; when done, the operational definitions and methods varied widely, making comparisons across programs unreliable. There is a pressing need to determine which measures are the most feasible and reliable to collect, the most useful for clinical counseling, and most informative for program management.

Key Words: adherence • defaulting • antiretroviral medications • East Africa

This version was published on July 1, 2008

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 7, No. 4, 193-199 (2008)
DOI: 10.1177/1545109708320687


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