New Manual Released to Help Health Facilities Determine Adherence Rates to AIDS Treatment

May 11, 2011 - The International Network for the Rational Use of Drugs Initiative on Adherence to Antiretrovirals (INRUD-IAA) has developed a simple, low-cost approach to collecting and analyzing facility level data on adherence to antiretroviral treatment (ART).   

The manual, How to Investigate Adherence to Antiretroviral Treatment, is a step-by-step guide on how to design and carry out a national or facility level survey to determine:

  • How a facility is doing at any given time
  • How it is doing over time
  • How it compares to other facilities
  • The effectiveness of interventions to improve adherence levels

By using the manual, managers responsible for HIV & AIDS prevention and treatment programs can identify facilities where they need to intervene to improve adherence levels and what the causes of poor performance might be. After implementing system changes to improve performance, managers can periodically repeat the survey to assess whether improvements have been made and are being maintained.

How to Investigate Adherence to Antiretroviral Treatment is currently available on the INRUD website ( and on a CD-ROM which is available on request (

“Lack of adherence to antiretroviral therapy (ART) for HIV/AIDS will not only result in treatment failure but it will also increase the likelihood of developing resistance to the medicines,” said John Chalker, INRUD-IAA project coordinator. “Resistance impacts individual patient as well as population-based outcomes. It is a major public health concern.”

Although ultimately the individual patient is the key to medicine-taking adherence, barriers to adherence are often associated with health care facilities. The survey manual facilitates collection and analysis of data on appointment keeping and the proportion of days covered by medicine dispensed over the last six months, as well as self reported adherence, all of which are validated indicators of adherence. In surveys in four East African countries conducted by INRUD-IAA in 2006 and 2007, the median facility achieved a dispensing coverage for their patients of 90% or more. Encouragingly, this means that most facilities surveyed are maintaining high rates of patient adherence and attendance. However, there are other facilities with low measures that need system strengthening. The coverage in some individual facilities was less than 80% with as many as 42% of patients experiencing a gap in medication of 30 days or more. Such gaps can lead to treatment failure or resistance development.

Through regular monitoring of adherence rates, ART program and facility managers, can identify possible causes of poor adherence and defaulting and institute facility level changes to help address the problems.

INRUD-IAA is a collaborative effort led by Management Sciences for Health working with Harvard University, Karolinska Institute, and the World Health Organization. The project is funded by the Swedish International Development Cooperation Agency. For more information on the initiative go to

For additional information or to arrange for a press interview, please contact Marie Maroun at 703.310.3428 or

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