-IAA The Dispensing Based Retrospective Data Collection Adherence Assessment Survey Dispensing 1

-IAA The Dispensing-based Retrospective Data Collection The main purpose of this exercise is to find all the adherence indicators except the self report of the exit interview. As such, it is the single most important exercise of the survey. Dispensing 2

-IAA Sampling 100 Patient Records The goal is to follow 100 patient records for six months Therefore, the sample should be of patients who attended eight months before For example, the data collection is during October, so sample patients who attended during March If the patient attended end of March, then six months is completed at the end of September It is advisable to sample 120 records to end with 100 usable ones Dispensing 3

Sampling 100 Patient Records Survey Data Collection Month Retrospective Sample Month the Previous January June February July March August April September May October June November July December August January September February October March November April December May Dispensing 4

-IAA Retrospective Sampling Methods— Examples of Different Situations Functioning attendance register and patient identification numbers There is an attendance register, but it does not distinguish between those on ART and those not on ART. However, there is an ART Initiation Register There is no attendance register, and no ART Initiation Register, but patient identifier number is in order of initiation There is no attendance register, no ART Initiation Register, and patient identification number is not in order of ART initiation. Dispensing 5

Methods of Retrospective Sampling-1 Functioning attendance register and patient identification numbers Yes There is an attendance register, but it does not distinguish between those on ART and those not on ART—however, there is an ART Initiation Register Randomly sample patients on ART attending in the relevant month and write their name and number on the patient identification sheets. Then pull their pharmacy records. If most patients are seen every month use ART initiation register. Evenly sample from all the patients who have initiated ART from when the clinic started to up to the end of the month you are sampling. As a last resort—sample many more than 120 from the attendance register to end up with 100 patients on ART No Dispensing 6 No

Methods of Retrospective Sampling-2 There is no attendance register, and no ART Initiation Register, but patient identifier number is in order of initiation Yes No Yes No No attendance register, no ART Initiation Register. The patient identification numbers are not allocated in order of ART initiation. Check how the pharmacy and clinical notes are stored. If stored in patient identifier order numbers find which number had started by the end of the month for which you are interested and sample all patients who had started before then. Check the total number of patients on ART now. Check the total number that were on ART 7 months before. Sample from all patients. Sampled size should correspond to the proportion patients started before the end of the month you are interested in. Dispensing 7

-IAA Retrospective Sampling methods Any set of circumstances may be met in practice So far (after 80 facilities in 4 countries), it has always been possible to devise a sensible system for sampling records You may need to be creative The key is to understand the recording and storage systems for both the pharmacy records and the attendance register information Dispensing 8

Retrospective Form Retrospective Dispensing Data Date of Entry Facility names ABCDEGH Seq. No. Patient identifier Initiation of ARVs Index Visit Dispensing Age in Yrs at index visit Gender M/F Date initiation ARVs Index visit Date any ARV drugs dispensed (dd/mm/yy) # days of ART dispensed on that day Dispensing 9 Take the manual (Chapter 4) and go over filling in the form, column by column.

Retrospective Form FACILITY # Name Data Collector JKNO Visit 2 DispensingVisit 3 Dispensing Date any ARV drugs dispensed (dd/mm/yy) # days of ART dispensed on that day Date any ARV drugs dispensed (dd/mm/yy) # days of ART dispensed on that day Dispensing 10

Retrospective Form BXBYBZCA If yesIf missed Did patient attend 3 months ago (Y/N) Attended next appt after visit 3 months ago (Y/N) Attended in next 3 days after missed appt (Y/N) Attended in next 30 days after missed visit (Y/N) Dispensing 11

Looking at Attendance The longest appointments are for three months This means we want to look at the appointment more than three months ago. For example, the data collection is during October Look at attendance during June Find what date the next appointment was given during this attendance Look at actual attendance and decide whether it was on or before the due date, within 3 days and within 30 days of due date and fill in accordingly Dispensing 12

Looking at Attendance Survey Data Collection Month For the Appointment after the Attendance month the previous January September February October March November April December May January June February July March August April September May October June November July December August Dispensing 13