Background: Lack of effective systems and tools to identify and track defaulters are
some of the factors that pose challenges in adherence monitoring for patients on antiretroviral
treatment (ART). An intervention was performed to introduce a facilitybased
appointment keeping system, and a revised clinic form to monitor patients’
adherence to ART.
Objective: To assess facility staff perceptions of, motivation for and self-reported
practice in the implementation, and on the use of adherence-based indicators to inform
decisions for performance improvement.
Design: Qualitative explorative study aiming to evaluate a quasi-experimental
intervention.
Settings: Six conveniently sampled health facilities in Kenya located in Central, Eastern
and Rift Valley provinces.
Subjects: Thirty-six clinic staff members were interviewed, six at each facility, including
facility managers, clinicians, nursing and pharmacy staff, counsellors, health records
information officers and social workers. Analysis was performed in line with the
Pettigrew and Whipp framework.
Results: Providers perceived that the intervention had empowered them to assess their
clinic’s daily workload and to identify those patients who missed their appointments.
Factors enhancing the positive uptake of the intervention included the availability of
tools to monitor appointment keeping, training on adherence principles and supervisory
support. Early detection of treatment defaulters helped the providers design targeted
patient support to enhance appointment keeping.
Conclusion: The effect of the intervention led to implementation of changes within the
clinic to enhance patients’ appointment keeping and improve adherence to treatment.
We expect the reported and observed changes to be sustainable as data generation and
calculation of indicators to inform decision-making were performed by the providers
themselves.