| Selke et al
14
| Kenya |
Study design: cluster randomised trial
Description of interventions:
Non-pharmacy personnel (home-based) group:
Community care counsellors were:
Clinically stable patients with self-reported 100% adherence to ART over the 6-month period before recruitment. A patient considered by the clinic staff to be good role model and mentor for other patients.
Duties for caregivers during home visits:
Obtained and entered data concerning patients’ symptoms Vital sign assessment. Assessment of adherence to ART and opportunistic infections prophylaxis. Distributed a 1 month supply of the patients’ medications (from a prefilled kit).
Pharmacy personnel (facility-based) group:
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| Jaffar et al
23
| Uganda |
Study design: cluster-randomised trial
Description of interventions:
Non-pharmacy personnel (home-based care) group:
Field workers with degree or college diploma who received a week of intensive training at start of study and yearly refresher courses on: Field workers visited patients in the homes on motor bikes every month to: deliver drugs monitor participants with a checklist of signs and symptoms of drug toxicity and disease progression provide adherence support referred patients to physician or counsellor at the clinic when judged necessary.
At 2 and 6 months after starting therapy, all patients were reviewed by a medical officer at the clinic and then at the 12th month. Drugs were not dispensed during the clinic visits for this group. Patients were visited again when not found at home. Patients asked to come to clinic when unwell.
Pharmacy personnel (facility-based) group:
Patients collected drugs every month from the pharmacy. Routine reviews by a medical officer and counsellor at 2 and 3 months after start of treatment and every 3 months thereafter. Patients assessed by a nurse and referred to a doctor when necessary during clinic visits. Patients followed up at home by field workers when missed an appointment. Patients received vouchers for their households for free voluntary counselling and testing at the clinic. Patients asked to come to clinic when unwell.
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Plasma RNA VL >500 copies per millilitre. Either plasma RNA >500 copies per millilitre if undetectable at 6 months, or an increase of 1000 copies between two consecutive tests if RNA detectable at 6 months. All-cause mortality. Mortality or plasma RNA VL >500 copies per millilitre. Admitted on one or more occasions. All admissions. Death, first admission or change to second-line therapy. Frequency of outpatient attendance. Adherence. Costs of health service delivery and costs incurred by patients to access care.
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| Silveira et al
24
| Brazil |
Study design: individually randomised trial.
Description of interventions:
Pharmacy personnel group:
Patients received this intervention onatients received this intervention on a monthly basis through the Da′der method, which consisted a series of scheduled meetings where the pharmacist and patient addressed, reviewed and solved drug-related problems for a 12-month period. Patients received structured counselling from pharmacists on their prescription regimens at the time of their initial drug dispensing and at monthly refill visits.
Key elements included:
Reviewing the prescription with the patient. Reviewing a card on which medications were colour-coded to facilitate recognition and reduce confusion that might arise from complicated drug names. Reviewing the schedule, length and date of next appointment. Reviewing patient’s understanding of the prescription by asking patient to describe it and giving patients verbal information on the expected side effects of their medications and instructing them to seek medical assistance by calling the pharmacist if side effects occurred.
Non-pharmacy personnel group:
Patients received usual care (UC) for ART drug distribution. The control group received UC for ART drug delivery. This included the following:
At the first appointment, when patients received their medications, a nurse first provided information on:
Afterwards, patients picked up their medications at a drug-dispensation counter. They had no encounters with a pharmacist. Patients were informed that they could schedule time with a nurse for any questions about their treatment or disease.
In both groups, patients were scheduled every 4 months for medical appointments and measurements of viral load and CD4 count. Participants who did not appear for their regularly scheduled appointment were contacted by telephone and asked to return. |
Self-reported adherence calculated by taking the number of tablets that patients reported ingesting and dividing it by the number they should have ingested. Patients were classified as adherent if they reported using 95% or more of the tablets prescribed Depression: this was investigated using a validated Portuguese-language version of the Beck Depression Inventory (BDI) with standard scoring
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