"They just come, pick and go." The Acceptability of Integrated Medication Adherence Clubs for HIV and Non Communicable Disease (NCD) Patients in Kibera, Kenya

Abstract

IntroductionThe number of people on antiretroviral therapy (ART) for the long-term management of HIV in low- and middle-income countries (LMICs) is continuing to increase, along with the prevalence of Non-Communicable Diseases (NCDs). The need to provide large volumes of HIV patients with ART has led to significant adaptations in how medication is delivered, but access to NCD care remains limited in many contexts. Medication Adherence Clubs (MACs) were established in Kibera, Kenya to address the large numbers of patients requiring chronic HIV and/or NCD care. Stable NCD and HIV patients can now collect their chronic medication every three months through a club, rather than through individual clinic appointments.MethodologyWe conducted a qualitative research study to assess patient and health-care worker perceptions and experiences of MACs in the urban informal settlement of Kibera, Kenya. A total of 106 patients (with HIV and/or other NCDs) and health-care workers were purposively sampled and included in the study. Ten focus groups and 19 in-depth interviews were conducted and 15 sessions of participant observation were carried out at the clinic where the MACs took place. Thematic data analysis was conducted using NVivo software, and coding focussed on people’s experiences of MACs, the challenges they faced and their perceptions about models of care for chronic conditions.ResultsMACs were considered acceptable to patients and health-care workers because they saved time, prevented unnecessary queues in the clinic and provided people with health education and group support whilst they collected their medication. Some patients and health-care workers felt that MACs reduced stigma for HIV positive patients by treating HIV as any other chronic condition. Staff and patients reported challenges recruiting patients into MACs, including patients not fully understanding the eligibility criteria for the clubs. There were also some practical challenges during the implementation of the clubs, but MACs have shown that it is possible to learn from ART provision and enable stable HIV and NCD patients to collect chronic medication together in a group.ConclusionsExtending models of care previously only offered to HIV-positive cohorts to NCD patients can help to de-stigmatise HIV, allow for the efficient clinical management of co-morbidities and enable patients to benefit from peer support. Through MACs, we have demonstrated that an integrated approach to providing medication for chronic diseases including HIV can be implemented in resource-poor settings and could thus be rolled out in other similar contexts.

Retention on ART and predictors of disengagement from care in several alternative community‐centred ART refill models in rural Swaziland

“…It also appears attractive for patients due to shorter waiting time at facility level. However, this care model does not contain the peer to peer support component which allegedly is one of the advantages of the other community‐based ART models . A qualitative understanding of patient preference for one community ART model compared with another is warranted, but was out of the scope of this implementation and analysis.…”

“…Implementation of patient‐centred ART care has been reported from several settings in sub‐Saharan Africa . Community ART Groups (CAGs) have been piloted in Malawi, Lesotho and Mozambique as a way to reduce patient time and costs spent travelling and queuing for ART refills .…”

“…In Mozambique the CAG model retained 97.7% and 91.8% of patients at 12, and 48 months . Facility‐based treatment clubs, also known as adherence clubs, were piloted in South Africa and Kenya with the aim to decongest facilities, increase retention in care and lower service provider cost . The results showed 97% retention in care for the club patients compared with 85% for other patients not enrolled in the model .…”

Patient–provider perspectives on self‐management support and patient empowerment in chronic care: A mixed‐methods study in a rural sub‐Saharan setting

“…Although patients expressed desire to join these groups, patient‐level factors (such as motivation, awareness) and group composition (membership fee, condition‐bound), inhibited patients from benefiting from these resources. While patients valued and gave recommendations to restructure peer‐support groups to cater for other chronic conditions, studies elsewhere (Khabala et al, ; Stockton, Giger, & Nyblade, ; Venables et al, ), caution that efforts towards consolidation of peer‐support groups should take care of potentially sensitive issues; such as dealing with stigma and disclosure, or unintentional divisions that may emerge due to preferential treatment for certain patient groups (Men, Meessen, Van Pelt, Van Damme, & Lucas, ).…”

“…While patients valued and gave recommendations to restructure peer-support groups to cater for other chronic conditions, studies elsewhere (Khabala et al, 2015;Stockton, Giger, & Nyblade, 2018;Venables et al, 2016), caution that efforts towards consolidation of peer-support groups should take care of potentially sensitive issues; such as dealing with stigma and disclosure, or unintentional divisions that may emerge due to preferential treatment for certain patient groups (Men, Meessen, Van Pelt, Van Damme, & Lucas, 2012).…”