Number and percentage of people starting antiretroviral therapy who picked up all prescribed antiretroviral drugs on time

Export Indicator

Number and percentage of people starting antiretroviral therapy who picked up all prescribed antiretroviral drugs on time On-time drug pick-up is defined as picking up antiretroviral drugs at each of the monitored pick-ups before the antiretroviral drugs
What it measures

Evaluating whether people have periods
during which they have no antiretroviral drugs available through the extent to which they pick up
antiretroviral drugs on time has been shown to be highly associated with antiretroviral failure and is one
potentially useful and low-cost method of identifying people at high risk for failure in resource-limited
settings. In addition, if more than 10 percent of people are picking up their antiretroviral drugs after their previously dispensed antiretroviral drugs run out, this may indicate that an underlying programmatic problem that affects the quality of services provided (such as the cost of drugs or clinic appointments, transport, clinic hours or a combination of issues) should be addressed.

Rationale

Developing simple, affordable ways of monitoring people after they initiate antiretroviral therapy has
become a major public health priority. Since the central paradigm of antiretroviral therapy is suppression
of viral replication and since the costs of second-line regimens are higher than those of first-line
regimens, monitoring efforts should largely focus on preserving the antiretroviral effectiveness of first-
line combinations. Failure to identify people who are at high risk of future antiretroviral failure or who
are currently on partly suppressive regimens may result in resistance to antiretroviral drugs, which has
been associated with more rapid disease progression and death.

Numerator

Number of people who have picked up all their prescribed antiretroviral drugs on time for
two consecutive drug pick-ups after a selected month

Denominator

Number of people who picked up antiretroviral drugs during a selected month

Calculation

Numerator / Denominator

Method of measurement

Identifying the people who picked up antiretroviral drugs during the selected month is easy at sites
with electronic or manual antiretroviral drug pick-up, pharmacy registers or dispensing records that
include personal identifiers arranged sequentially by date. Data abstractors should record the following
information for each patient who picked up antiretroviral drugs in the selected month:
-a patient identifier;
-the last antiretroviral drug pick-up during the selected month (baseline pick-up);
-the two consecutive antiretroviral drug pick-up dates after the selected month (pick-up 1 and pick-up 2)
-the list of antiretroviral drugs, including number of days, or pill number, number of pills in a dose and frequency of doses to be taken that were dispensed (or in hand on leaving the pharmacy) at the baseline pick-up and pick up1;
- the date of transfer out after baseline pick-up if two antiretroviral drug pick-ups were not recorded after the baseline pick-up;
-the date of death after baseline pick-up if two antiretroviral pick-ups were not recorded after the baseline pick-up; and
-the date antiretroviral therapy stopped after the baseline pick-up (that is , a recorded decision by the person receiving antiretroviral therapy or physician that no more antiretroviral drugs should be dispensed) if two antiretroviral pick-ups were not recorded after the baseline pick-up.

For more details on data of the indicator, see HIV drug resistance early
warning indicators.
Countries can also collect the following indicator: percentage of people initiating antiretroviral therapy
at the site during a selected time period who picked up all prescribed antiretroviral drugs on time during
their first 12 months of antiretroviral therapy (cohort). For more details, see HIV drug resistance early
warning indicators.

Measurement frequency

Annual

Disaggregation
Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses
Further information