Acceptability of community-based adherence clubs among health facility staff in South Africa: a qualitative study

Abstract

BackgroundPatient retention in care for HIV/AIDS is a critical challenge for antiretroviral treatment programs. Community-based adherence programs (CBAPs) as compared to health care facility-based adherence programs have been considered as one of the options to provide treatment maintenance support for groups of patients on antiretroviral therapy. Such an approach provides a way of enhancing self-management of the patient’s condition. In addition, CBAPs have been implemented to support antiretroviral treatment expansion in resource-limited settings. CBAPs involve 30 patients that are allocated to a group and meet at either a facility or a community venue for less than an hour every 2 or 3 months depending on the supply of medication. Our study aimed to establish perceived challenges in moving adherence clubs from health facilities to communities.MethodsA qualitative study was conducted in 39 clinics in Mpumalanga and Gauteng Provinces in South Africa between December 2015 and January 2016. Purposive sampling method was used to identify nurses, club managers, data capturers, pharmacists and pharmacy assistants who had been involved in facility-based treatment adherence clubs. Key-informant interviews were conducted. Also, semi-structured interviews were used and thematic content analysis was done.ResultsA total of 53 health care workers, 12 (22.6%) males and 41 (77.4%) females, participated in the study. Most of them 49 (92.5%) indicated that participating in community adherence clubs were a good idea. Reduction in waiting time at the health facilities, in defaulter rate, improvement in adherence to treatment as well as reduction in stigma were some of the perceived benefits. However, security of medication, storage conditions and transportation of the prepacked medication to the distribution sites were the areas of concern.ConclusionHealth care workers were agreeable to idea of the moving adherence clubs from health facilities to communities. Although some challenges were identified, these could be addressed by the key stakeholders. However, government and nongovernmental organizations need to exercise caution when transitioning to community-based adherence clubs.

Retention in care and factors critical for effectively implementing antiretroviral adherence clubs in a rural district in South Africa

“…Previous publications have reported concern over stigma in a club setting [26], and some clients did report fears of being recognized by community members when attending the clubs. In contrast to other published data [15], ART stock-outs were not reported as a challenge. ART stock-outs are rare in the Western Cape and it may be that timeous provision of ART is more of a challenge in other settings.…”

“…Perceived advantages of adherence clubs include improved access to services with reduced waiting times, social networking associated with being managed as a group , and an increased role for community healthcare workers (CHWs) . However, healthcare workers have expressed concerns about lack of control of adherence club activities, particularly with respect to provision of ART and other chronic disease medications .…”

“…Perceived advantages of adherence clubs include improved access to services with reduced waiting times, social networking associated with being managed as a group [15], and an increased role for community healthcare workers (CHWs) [13,16]. However, healthcare workers have expressed concerns about lack of control of adherence club activities, particularly with respect to provision of ART and other chronic disease medications [7,13,15]. This study reported on clinical outcomes among ART clients attending adherence clubs and client experiences and healthcare worker perceptions of factors key to successful adherence club implementation in the Cape Winelands District, South Africa.…”

Exploration of Adherence Clubs as a Model of Care for Patients: a Literature Review

“…One study has revealed that males who had long-term housing, living with a partner and belonged to an HIV support group had better antiretroviral adherence (Malta et al, 2010; Wasti et al, 2012). The convenience of picking medication from the community-based adherence clubs leads to a reduction in the numbers of club members sending their friends and family members to pick up the medication this increases interactions with healthcare worker (Tshuma et al, 2017).…”

“…Adherence clubs have been implemented to support antiretroviral treatment expansion in resource-limited settings. These clubs involve 30 patients that are allocated to a group and meet at either a facility or a community venue for less than an hour every 2 or 3 months depending on the supply of medication (Bemelmans et Tshuma et al, 2017). For purposes of this study, though particular emphasis will be on patients that are in adherence clubs, we will use any literature that relates to interventions targeted at patients on ART and chronic medication that seek to retain patients in care.…”