161 Although each of the many types of monitoring methods has its limitations, 157 158 adherence data can help to inform the statistical analysis (Item 20c), trial interpretation, and choice of appropriate adherence strategies to implement in the trial as it progresses or in future trials and clinical practice.
Yet, this aspect of our study also mirrors clinical practice, as providers are not required to systematically assess adherence prior to implementing management changes.
An intensive psychological support that improved adherence to treatment was implemented by one of the authors (C. O. C. R .. Fifty-one (73%) of the 70 patients were premenopausal: they received a leuteinizing hormoneion [ 23].
The national scale-up of a CHW programme for ART is conceivable only in a strong health system that can provide regular follow-up training, organize and sustain adequate support and supervision, ensure adherence to protocols and implement and enforce a regulatory framework.
Consumer education and provider training are expected to accelerate progress towards desired levels of coverage and adherence, cost relatively little to implement, and can therefore be considered also economically attractive.
In addition, efforts have been made to implement adherence to chronic treatment, which translates into clinical benefit.
The poor longitudinal ARV adherence highlights critical challenges to implementing the WHO 2010 guidelines.
This finding may be also partly related to the availability and increasing use of fixed dose combinations containing FTC, which have been shown to implement adherence [ 33, 34].
In addition, in settings with low adherence, it might be more cost effective to implement low cost adherence interventions such as counselling and pill counts before viral load testing.
No mechanisms to control adherence to guidelines have been implemented so far.
