Strengthening the appointment and tracking systems for patients on antiretroviral therapy in Tanzania: A optimizing adherence to ART as part of people-centered public health

Article Sidebar

Requires Subscription or Fee PDF (USD 25)
Published: Dec 6, 2012
DOI: https://doi.org/10.5750/ijpcm.v2i4.302
Keywords:
Adherence adherence indicator antiretroviral therapy appointment system people-centered public health Tanzania

Main Article Content

Salama Mwatawala
Management Sciences for Health/Center for Pharmaceutical Management, Dar es Salaam
David Sando
Ministry of Health and Social Welfare, National AIDS Control Program, Dar es Salaam
Rainalds Soni Malele
Muhimbili University of Health and Allied Sciences & Secretary for Tanzania International Network for the Rational Use of Drugs, Dar es Salaam
Candida Moshiro
Muhimbili University of Health and Allied Sciences & Secretary for Tanzania International Network for the Rational Use of Drugs, Dar es Salaam
Bernard Rabiel Senyael
Ministry of Health and Social Welfare, National AIDS Control Program, Dar es Salaam
Geofrey Somi
Ministry of Health and Social Welfare, National AIDS Control Program, Dar es Salaam
Amos Maselle
Muhimbili University of Health and Allied Sciences & Coordinator of Tanzanian International Network for the Rational Use of Drugs, Dar es Salaam
John Chalker
Management Sciences for Health/Center for Pharmaceutical Management
Dennis Ross-Degnan
Harvard Medical School and Director of Research, Harvard Pilgrim Health Care Institute, Drug Policy Research Group, Dept. of Population Medicines, Boston

Abstract

Rationale, aims, and objectives: For a successful patient outcome, a high level of adherence to antiretroviral therapy (ART) is needed. A 2008 report in Tanzania indicated poor clinic attendance and a high lost to follow-up rate as major threats to optimal ART program effectiveness. Most clinics lack a standardized appointment system, which leads to poor records on patients who are expected to attend the clinic. As a result, no one knows if scheduled patients have arrived and no standardized system exists to early track patients missing clinic. Those facilities that do follow patients mainly track those who are categorized as lost to follow-up, when it is already too late to avoid drug resistance and treatment failure. The objective of this study was to assess the effectiveness of strengthening appointment and tracking systems in improving patient attendance at ART clinics in Tanzania as part of people-centered approaches to public health.Methods: In each of 2 regions, we selected 3 intervention facilities and 1 control facility. Inclusion criteria were facilities that had at least 150 patients on ART and were accessible by the study team. At each facility, we recruited a cohort of 100 patients who had been on treatment for at least 9 months at baseline. The intervention involved introducing a standardized appointment register, negotiating appointments with patients and strengthening linkage with communities to trace patients who missed appointments. The primary outcome indicator was the percentage of patients who missed visits by either more than 3 days or more than 14 days. An interrupted time series analysis was applied and comparisons were made with the control group.Results: Results showed that in both regions, between 15% and 20% of patients missed visits by more than 3 days each month prior to the interventions. After the intervention, the rate declined to about 11% in Region 1, but did not decline in Region 2 or in the control facilities.Conclusions: The interventions had some impact on improving appointment-keeping and adherence to ART among patients in Tanzania. Effective appointment systems and strengthening linkage with community programs are feasible and sustainable approaches to reduce high rates of missed visits and enhance people-centered public health.

Article Details

Issue
Vol. 2 No. 4 (2012)
Section
Regular Articles

References

Amico, K.R., Harman, J.J. & O'Grady, M.A. (2008). Attrition and related trends in scientific rigor: a score card for ART adherence intervention research and recommendations for future directions. Current HIV/AIDS Reports 5 (4) 172-185.

Remien, R.H., Bastos, F.I., Terto, Jnr, V., Raxach, J.C., Pinto, R.M., Parker, R.G., Berkman, A.M. & Hacker, A. (2007). Adherence to antiretroviral therapy in a context of universal access, in Rio de Janeiro, Brazil, AIDS Care 19 (6) 740 -748.

Weiser, S., Wolfe, W. & Bangsberg, D. R. (2003). Barriers to antiretroviral adherence for patients living with HIVinfection and AIDS in Botswana. Journal of Acquired Immune Deficiency Syndromes 34 (3) 281-288.

Swai, R., Somi, G. & Sando, D. (2007). Evaluation of ART adherence measurement tool in the context of Tanzanian health care system. National AIDS Control Programme Report. Dar es Salam, Tanzania: Ministry of Health and Social Welfare, National AIDS Control Programme.

Ministry of Health and Social Welfare, National AIDS Control Programme. (2008). Implementation of HIV AIDS Care and Treatment Services in Tanzania, Report Number 1. Dar es Salam, Tanzania: MOHSW.

Chalker, J., Andualem, T., Gitau, L., Ntaganira, J., Waako, P., Obua, C. & Ross-Degnan, D. A on behalf of the INRUD-IAA Project. (2010). Measuring adherence to antiretroviral treatment in resource poor settings using available data: A health system approach. BMC Health Services Research 10, 43.

Ross-Degnan, D., Pierre-Jacques, M., Zhang, F., Tadeg, H., Gitau, L., Ntaganira, J., Balikuddembe, R., Chalker, J., Wagner, A.K., & INRUD IAA. (2010). Measuring adherence to antiretroviral treatment in resource-poor settings: The clinical validity of key indicators. BMC Health Services Research 10, 42.

Ministry of Health and Social Welfare, National Aids Control Programme. (2011). Implementation of HIV AIDS Care and Treatment Services in Tanzania, Report Number 2. Abbreviated Edition. Dar es Salam, Tanzania: MOHSW.

Cantrell, R.A., Sinkala, M., Megazinni, K., Lawson-Marriott, S., Washington, S., Chi, B.H., Tambatamba-Chapula, B., Levy, J., Stringer, E. M., Mulenga, L. & Stringer, J.S. (2008). A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. Journal of Acquired Immune Deficiency Syndromes 49 (2) 190-195.

Van Winghem, J., Telfer, B., Reid, T., Ouk, J., Mutunga, A., Jama, Z. & Vakil, S. (2008). Implementation of a comprehensive program including psycho-social and treatment literacy activities to improve adherence to HIV care and treatment for a pediatric population in Kenya. BMC Pediatrics 8, 52.

Mugusi, F., Mugusi, S., Bakari, M., Hejdemann, B., Josiah, R., Janabi, M., Aboud, S., Aris, E., Swai, H., Mhalu, F., Biberfeld, G., Pallangyo, K. & Sandstrom, E. (2009). Enhancing adherence to antiretroviral therapy at the HIV clinic in resource constrained countries; the Tanzanian experience. Tropical Medicine and International Health 14 (10) 1226-1232.

Sabin, L.L., DeSilva, M.B., Hamer, D.H., Xu, K., Zhang, J., Li, T., Wilson, I.B., & Gil, C.J. (2010). Using electronic drug monitor feedback to improve adherence to antiretroviral therapy among HIV-positive patients in China. Archives of Physical Medicine and Rehabilitation 14 (3) 580-589.

Shet, A., Arumugam, K., Rodrigues, R., Rajagopalan, N., Shubha, K., Raj, T., D'Souza, G. & De Costa, A. (2010). Designing a mobile phone-based intervention to promote adherence to antiretroviral therapy in South India. Archives of Physical Medicine and Rehabilitation 14 (3) 716-720.

Lester, R.T., Ritvo, P., Mills, E.J., Kariri, A., Karanja, S., Chung, M.H., Jack, W., Habyarimana, J., Sadatsafavi, M., Najafzadeh, M., Marra, C.A., Estambale, B., Nquqi, E., Ball, T.B., Thabane, L., Gelmon, L.J., Kimani, J., Ackers, M. & Plummer, F.A. (2010). Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet 376 (9755) 1838-1845.

Rochon, D., Ross, M.W., Looney, C., Nepal, V.P., Price, A.J. & Giordano, T.P. (2011). Communication strategies to improve HIV treatment adherence. Profiles in Healthcare Commuications 26 (5) 461-467.

Thomson, K.A., Cheti, E.O. & Reid, T. (2011). Implementation and outcomes of an active defaulter tracing system for HIV, prevention of mother to child transmission of HIV (PMTCT), and TB patients in Kibera, Nairobi, Kenya. Transactions of the Royal Society of Tropical Medicine and Hygiene 105 (6) 320-326.

Van Servellen, G., Chang, B., Garcia, L. & Lombardi, E. (2002). Individual and system level factors associated with treatment non adherence in Human Immunodeficiency Virus-infected Men and Women. AIDS Patient Care and STDs 16 (6) 269-281.

Shadish, W.R., Cook, T.D. & Campbel, D.T. (2002). Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Boston: Houghton Mifflin Company.

Etienne, M., Burrows, L., Osotimehin, B., Macharia, T., Hossain, B., Redfield, R. R. & Amoroso, A, (2010). Situational analysis of varying models of adherence support and loss to follow up rates; findings from 27 treatment facilities in eight resource limited countries. Tropical Medicine and International Health 15 (Supplement 1) 76-81.

Forster, M., Bailey, C., Brinkhof, M.W., Graber,C., Boulle, A., Spohr, M., Balestre, E., May, M., Keiser, O., Jahn, A. & Egger, M. (2008). Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settings. Bulletin of the World Health Organization 86 (12) 939-947.

Kabore, I., Bloem, J., Etheredge, G., Obiero, W., Wanless, S., Doykos, P., Ntsekhe, P., Mtshali, N., Afrikaner, E., Sayed, R., Bostwelelo, J., Hani, A., Moshabesha, T., Kalaka, A., Mameja, J., Zwane, N., Shongwe, N., Mtshali, P., Mohr, B., Smuts, A. & Tiam, A. (2010). The effect of community-based support services on clinical efficacy and health-related quality of life in HIV/AIDS patients in resource-limited settings in sub-Saharan Africa. AIDS Patient Care & STDs 24 (9) 581-594.

Yu, J.K., Chen, S.C., Wang, K.Y., Chang, C.S., Makombe, S.D., Schouten, E. J. & Harries, A.D. (2007). True outcomes for patients on antiretroviral therapy who are "lost to follow-up" in Malawi. Bulletin of the World Health Organization 85 (7) 550-554.

Krebs, D.W., Chi, B.H., Mulenga, Y., Morris, M., Cantrell, R.A., Mulenga, L., Levy, J., Sinkala, M. & Stringer, J.S. (2008) Community-based follow-up for late patients enrolled in a district-wide programme for antiretroviral therapy in Lusaka, Zambia. AIDS Care 20 (3) 311-317.

Kunutsor, S., Walley, J., Katabira, E., Muchuro, S., Balidawa, H., Namagala, E. & Ikoona, E. (2010). Using mobile phones to improve clinic attendance amongst an antiretroviral treatment cohort in rural Uganda: a cross-sectional and prospective study. AIDS and Behavior 14 (6) 1347-1352.

Mukund Bahadur, K.C. & Murray, P.J. (2010). Cell phone short messaging service (SMS) for HIV/AIDS in South Africa: a literature review. Studies in Health Technology and Informatics 160 (1) 530-534.

Wagner, A.K., Soumerai, S.B., Zhang, F. & Ross-Degnan, D. (2002). Segmented regression analysis of interrupted time series studies in medication use research. Journal of Clinical Pharmacy and Therapeutics 27 (4) 299-309.