Patient Preference and Adherence (Sep 2017)
Acceptability of community-based adherence clubs among health facility staff in South Africa: a qualitative study
Abstract
Ndumiso Tshuma,1,2 Ofentse Mosikare,1,2 Jessica A Yun,1 Olufunke A Alaba,3 Meera S Maheedhariah,4 Keith Muloongo,1,2 Peter S Nyasulu2,5,61Community AIDS Response, Johannesburg, South Africa; 2School of Health Sciences, Monash University South Africa, Johannesburg, South Africa; 3School of Public Health and Family Medicine, University of Cape Town, South Africa; 4Department of Human Behaviour, College of South Nevada and University of California, Los Angeles, CA, USA; 5School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 6Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South AfricaBackground: Patient 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.Methods: A qualitative study was conducted in 39 clinics in Mpumalanga and Gauteng Provinces in South Africa between December 2015 and January 2016. Purposive sampling methods 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.Results: A 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.Conclusion: Health 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.Keywords: adherence clubs, antiretroviral therapy, HIV, health facility, chronic clubs, cohorts, patient retention
