Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa

Abstract

BackgroundThe antiretroviral adherence club intervention was rolled out in primary health care facilities in the Western Cape province of South Africa to relieve clinic congestion, and improve retention in care, and treatment adherence in the face of growing patient loads. We adopted the realist evaluation approach to evaluate what aspects of antiretroviral club intervention works, for what sections of the patient population, and under which community and health systems contexts, to inform guidelines for scaling up of the intervention. In this article, we report on a step towards the development of a programme theory—the assumptions of programme designers and health service managers with regard to how and why the adherence club intervention is expected to achieve its goals and perceptions on how it has done so (or not).MethodsWe adopted an exploratory qualitative research design. We conducted a document review of 12 documents on the design and implementation of the adherence club intervention, and key informant interviews with 12 purposively selected programme designers and managers. Thematic content analysis was used to identify themes attributed to the programme actors, context, mechanisms, and outcomes. Using the context-mechanism-outcome configurational tool, we provided an explanatory focus of how the adherence club intervention is roll-out and works guided by the realist perspective.ResultsWe classified the assumptions of the adherence club designers and managers into the rollout, implementation, and utilisation of the adherence club programme, constructed around the providers, management/operational staff, and patients, respectively. Two rival theories were identified at the patient-perspective level. We used these perspectives to develop an initial programme theory of the adherence club intervention, which will be tested in a later phase.ConclusionThe perspectives of the programme designers and managers provided an important step towards developing an initial programme theory, which will guide our realist evaluation of the adherence club programme in South Africa.

ART adherence clubs in the Western Cape of South Africa: what does the sustainability framework tell us? A scoping literature review

“…In Figure the screening process is outlined in a PRISMA flow chart, and the characteristics of the included records are presented in Table . Of these six records, three are qualitative studies, with one poster presentation , one is a mixed‐method studies , while two are quantitative studies .…”

“…The rollout of ACs across the Cape Metro District in 2011 demonstrated great success in organization and implementation . Firstly, this achievement was based on a collaborative approach between the Western Cape Provincial DoH, City of Cape Town Health Department, MSF, and the Institute for Healthcare Improvement to support the implementation with a so‐called steering committee . Secondly, a strategy of quality improvement was established, expanding the club model based on a collaborative short‐term learning system .…”

“…Firstly, this achievement was based on a collaborative approach between the Western Cape Provincial DoH, City of Cape Town Health Department, MSF, and the Institute for Healthcare Improvement to support the implementation with a so‐called steering committee . Secondly, a strategy of quality improvement was established, expanding the club model based on a collaborative short‐term learning system . In practice, mentors and the steering committee provided learning sessions for the club teams to guide implementation and make use of feedback loops to report back on progress and any emerging challenges .…”

“…Secondly, a strategy of quality improvement was established, expanding the club model based on a collaborative short‐term learning system . In practice, mentors and the steering committee provided learning sessions for the club teams to guide implementation and make use of feedback loops to report back on progress and any emerging challenges . The steering committee undertook a key role in implementation and development of ACs .…”

“…In practice, mentors and the steering committee provided learning sessions for the club teams to guide implementation and make use of feedback loops to report back on progress and any emerging challenges . The steering committee undertook a key role in implementation and development of ACs . The literature highlighted the dependence on NGOs and non‐profit organizations (NPOs) for providing training and mentoring for club staff .…”