Development of a multi-method tool to measure ART adherence in resource-constrained settings : the South Africa experience

Ensuring adherence to antiretroviral therapy (ART) treatment is one of the key strategies that will delay emergence of resistant strains of the virus and ensure durability of the present regimens. Health care workers are not easily able to identify patients who may or may not adhere to treatment; formal measurement of adherence provides an opportunity for identifying patients who may require adherence support measures. The USAID-supported Management Sciences for Health RPM Plus Program is providing technical assistance and support to South Africa"s Department of Health (DOH) in the Comprehensive HIV and AIDS Care, Management and Treatment Plan for the development of strategies for adherence monitoring and measurement. The collaboration between the DOH and RPM Plus led to the development of a multi-method adherence assessment tool based on previously validated elements including self-report, visual analogue scale, pill identification test, and pill count. The use of this tool is expected to standardize adherence measurement in ART clinics and facilitate comparison of adherence rates and adherence support measures across facilities, thus leading to identification of support measures that are associated with higher adherence rates. This technical report provides an overview of ART adherence measurement and describes the process of developing the multi-method adherence assessment tool in South Africa. (Author abstract)