Page 156 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 14 Original Research

‘At this [adherence] club, we are a family now’: A realist

theory-testing case study of the antiretroviral treatment

adherence club, South Africa

Authors: Background: An estimated 7.9 million people were living with HIV in South Africa in 2017,
Ferdinand C. Mukumbang 1 with 63.3% of them remaining in antiretroviral therapy (ART) care and 62.9% accessing ART.
Brian van Wyk 1
2
Sara Van Belle Poor retention in care and suboptimal adherence to ART undermine the successful efforts of
Bruno Marchal initiating people living with HIV on ART. To address these challenges, the antiretroviral
1,2
adherence club intervention was designed to streamline ART services to ‘stable’ patients.
Affiliations: Nevertheless, it is poorly understood exactly how and why and under what health system
1 School of Public Health,
University of the Western conditions the adherence club intervention works.
Cape, Cape Town, South Africa
Objectives: The aim of this study was to test a theory on how and why the adherence club
2 Department of Public intervention works and in what health system context(s) in a primary healthcare facility in the
Health, Institute of Tropical Western Cape Province.
Medicine, Antwerp, Belgium
Method: Within the realist evaluation framework, we applied a confirmatory theory-testing
Corresponding author: case study approach. Kaplan–Meier descriptions were used to estimate the rates of dropout
Ferdinand Mukumbang, from the adherence club intervention and virological failure as the principal outcomes of the
[email protected]
adherence club intervention. Qualitative interviews and non-participant observations were
Dates: used to explore the context and identify the mechanisms that perpetuate the observed outcomes
Received: 03 Oct. 2018 or behaviours of the actors. Following the retroduction logic of making inferences, we configured
Accepted: 28 Feb. 2019 information obtained from quantitative and qualitative approaches using the intervention–
Published: 26 June 2019
context–actor–mechanism–outcome heuristic tool to formulate generative theories.
How to cite this article: Results: We confirmed that patients on ART in adherence clubs will continue to adhere to their
Mukumbang FC, Van Wyk B,
Van Belle S, Marchal B. medication and remain in care because their self-efficacy is improved; they are motivated or
‘At this [adherence] club, we are being nudged.
are a family now’: A realist
theory-testing case study of Conclusion: A theory-based understanding provides valuable lessons towards the adaptive
the antiretroviral treatment implementation of the adherence club intervention.
adherence club, South Africa.
S Afr J HIV Med. 2019;20(1), Keywords: Antiretroviral Treatment; Adherence Club; Medication Adherence; Retention in
a922. https://doi.org/10.4102/ Care; Realist Evaluation; South Africa.
sajhivmed.v20i1.922

Copyright:
© 2019. The Authors. Background
Licensee: AOSIS. This work
is licensed under the South Africa has the largest AIDS epidemic in the world, with an estimated 7.9 million people
1
Creative Commons living with HIV (PLHIV) as of 2017. The South African health system currently runs the largest
Attribution License. antiretroviral therapy (ART) programme in the world. Although major successes have been
2
achieved by the South African health system in responding to the HIV epidemic, yet challenges
remain. These challenges are reflected in the sustained high HIV incidence rates, poor retention
3
in ART care and suboptimal adherence to medication. Poor retention in care and suboptimal
2
adherence to medication threaten the success of the South African national ART programme.
With an estimated 4.44 million people initiated on ART to date and the recent adoption of the
1
‘test and treat’ approach, the need for sustainable programmes to improve the retention in care
4
and adherence to ART is critical.
A consolidated version of the World Health Organization’s (WHO’s) 2015 HIV treatment guideline
recommends the use of differentiated care models to improve the access and quality of treatment
Read online: and care services for PLHIV. Differentiated models adapt HIV treatment services to specific
4
Read online:
Scan this QR
Scan this QR patient populations and contexts, rather than adopting a one-size-fits-all approach. By tailoring
5
code with your
code with your
smart phone or services according to the needs of different patient groups, reducing clinic contact and relying on
smart phone or
mobile device
mobile device community-based services for quick medication access for the treatment of mature patients, these
to read online.
to read online.
models increase the capacity and efficiency of ART services.
http://www.sajhivmed.org.za 149 Open Access