Adherence & Retention
Handling of ARVs in DOT-HAART
Started by Stuart Mackenzie on 18 Jul 2008
Here in Lusaka, CIDRZ has a group of CHWs beginning a DOT-HAART pilot project at a government clinic. We have done our best not to disturb the current workings of the ART clinic, but the pharmacists are concerned over the prospect of CHWs taking responsibility for clients' ARVs. They would prefer that the clients themselves keep their ARVs so that if there is a conflict, they can take the drugs on their own. While not a bad fail-safe, this plan makes it much easier for a CHW to skip a daily visit or two and weakens the model of directly observed therapy. With our focus on improving Adherence, it is difficult to determine which method will be the most secure.
If members of the community have had success with either of these strategies, it would be very helpful to hear about it as we solidify our program. Thank you!
Keywords: Community Health Workers
Michael Rich, MD
I work in a Partners In Health Project in Rwanda. We have been using a DOTS-HAART model which we call “a daily accompaniment model” for the past three years. Three thousand patients are presently enrolled.
expand commentWe have had similar discussions around this issue. One solution is to leave a one day dose with the patient and tell them to only take if the CHW does not show up and come the very same day to the clinic. We do allow for if the CHW is going out of town to leave the medicines with another CHW, or if no one is available, with the patient. We try to be flexible and let the patient know that if he or she needs to leave the village that they can also take medicines with them. We usually give them a few extra tablets in case the are delayed for any reason.
We are pretty strict that if a CHW does not show up, and does not send word why they can not show up, they could loose their job. We stress the patient depends on them being on time every day. But we also try to be flexible to let CHW plan ...
2:34 PM, 25 Jul 2008 | Permalink
Chorongo Salee
Hi stuart
what a wonderful programme you are implementing .i did lead a team of community health workers in a operational research on adherence here at coast province general hospital mombasa kenya sponsored by population councill what i discovered is patient on arvs were happy to see they were visited at home and pill counts done to accertain level of adherence another thing is that chws should also be trained on confidentiality for the programme to be succeefull why dont you consider mombasa as one of your site i will assist you with the logistics your prgramme is good
9:41 AM, 21 Aug 2008 | Permalink