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Open Access Simplified methods of determining treatment retention in Malawi: ART cohort reports vs. pharmacy stock cards

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SETTING: Rapid scale-up of antiretroviral therapy (ART) has challenged the health system in Malawi to monitor large numbers of patients effectively.

OBJECTIVE: To compare two methods of determining retention on treatment: quarterly ART clinic data aggregation vs. pharmacy stock cards.

DESIGN: Between October 2010 and March 2011, data on ART outcomes were extracted from monitoring tools at five facilities. Pharmacy data on ART consumption were extracted. Workload for each method was observed and timed. We used intraclass correlation and Bland-Altman plots to compare the agreeability of both methods to determine treatment retention.

RESULTS: There is wide variability between ART clinic cohort data and pharmacy data to determine treatment retention due to divergence in data at sites with large numbers of patients. However, there is a non-significant trend towards agreeability between the two methods (intraclass correlation coefficient > 0.9; P > 0.05). Pharmacy stock card monitoring is more time-efficient than quarterly ART data aggregation (81 min vs. 573 min).

CONCLUSION: In low-resource settings, pharmacy records could be used to improve drug forecasting and estimate ART retention in a more time-efficient manner than quarterly data aggregation; however, a necessary precondition would be capacity building around pharmacy data management, particularly for large-sized cohorts.
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Keywords: ART retention; Malawi; drug forecasting; monitoring and evaluation of HIV programme

Document Type: Research Article

Affiliations: 1: Dignitas International, Zomba, Malawi; Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 2: Dignitas International, Zomba, Malawi; and University of Malawi, Chancellor College, Zomba, Malawi 3: Dignitas International, Zomba, Malawi 4: World Health Organization, Geneva, Switzerland 5: International Union Against Tuberculosis and Lung Disease, Paris, France; and London School of Hygiene & Tropical Medicine, London, UK

Publication date: June 21, 2012

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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