Improving ART adherence at reproductive and child health clinics integrating Option B+ in Tanzania

Abstract

The International Initiative for Impact Evaluation (3ie) is an international grant-making non-governmental organization promoting evidence-informed development policies and programs. We are the global leader in funding, producing and synthesizing high-quality evidence of what works, for whom, why and at what cost. We believe that high-quality and policy-relevant evidence will help make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, and use the most appropriate mix of methods to capture outcomes that are useful in complex developmental contexts. About this report3ie accepted the final version of the report, Improving adherence to ART at reproductive and child health clinics integrating Option B+ in Tanzania, as partial fulfillment of requirements under grant TW7.17 issued under the Integration HIV services thematic window. The content has been copy-edited and formatted for publication by 3ie. All the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its board of commissioners. Any errors and omissions are also the sole responsibility of the authors. All affiliations of the authors listed in the title page are those that were in effect at the time the report was accepted. Any comments or queries should be directed to the corresponding author, John Chalker, jchalker@msh.org. ii SummaryIn previous work in antiretroviral therapy (ART) clinics, Ross-Degnan and others have shown that the rate of a patient attending appointments on time in a particular facility correlates with their rate of medication adherence and clinical outcome (2010). ART clinics in three East African countries found that implementing a minimally invasive, lowcost patient appointment and tracking system allowed ART staff to identify missing patients promptly, facilitate the management of their workload and promote sustainable and consistent clinic attendance by HIV-positive patients (Nyamusore et al. 2011;Mwatawala et al. 2012; Boruett et al. 2013).In June 2013, Tanzania adopted Option B+, whereby all HIV-positive pregnant women receive all ART at reproductive and child health (RCH) clinics, rather than the specialized ART clinics, which had previously been the sole providers of ART. The Prevention of Mother-to-Child Transmission Unit of the Ministry of Health and Social Welfare distributed the appointment and patient tracking registers to all RCH Option B+ clinics but gave no formal orientation for their use. The Ministry of Health and Social Welfare reported that adherence and retention to treatment were problems.For this research, our goal was to conduct a cluster randomized controlled trial to evaluate whether orienting Option B+ RCH clinic staff on the use of the appointment and patient-tracking registers improves appointment attendance rates in these ...