Page 160 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 5 of 14 Original Research

The analysis of the qualitative data involved the coding of Our study participants revealed that at the time of the study,
the realist interview (semi-structured) transcripts. The coding there was a good buy-in from the operational staff regarding
process was done by the first author who has extensive the implementation of the adherence club programme. This
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knowledge on the subject matter, with a previously buy-in prompts them to work beyond the call of duty. For
validated coding frame by four authors that was based on the instance, a counsellor explained that rather than start the
initial programme theory (Appendix 1). After the coding adherence club sessions at 8 am, as originally scheduled, they
process, we classified the themes as a mechanism, context, start the club activities at 7 am to allow the patients to finish
actors, intervention and outcomes. at the club and still make it to their workplaces on time. This
is what the nurse had to say:
Ethical consideration ‘We have to have buy-in from everybody, so I also had to speak

Regarding the study participants, we first provided the to the pharmacists, telling them, “This is the plan, this is the
participants with an information sheet for the project. reason” and tell them how they are going to benefit by fewer
patients waiting in their waiting area.’ (Nurse 1, female)
This was followed by a verbal explanation of the role of the
participants and the significance of their participation. The
participants were required to sign an informed consent form. Integrated care
We promised and ensured confidentiality and anonymity Integrated care means providing services relating to not
by identifying the participants using pseudo names and only ART, but also services of other non-communicable
password-protecting all the study related files. This study is chronic diseases, such as hypertension, diabetes and epilepsy.
part of a larger project ‘A realist evaluation of the antiretroviral Patients having any other illness and who are on ART in the
treatment adherence club program in selected primary adherence club are also provided with services to manage
healthcare facilities in the metropolitan area of Western Cape the concomitant non-communicable chronic diseases. This
Province, South Africa’, which has received ethical clearance context encourages the successful implementation of the
from the Higher Degree’s Committee of the University of the adherence club regarding patients with comorbidities. The
Western Cape. In addition, we obtained ethical clearance from nurse participant explained how the notion of integrated care
the Provincial Department of Health of the Western Cape provides for a conducive environment for patients with other
Province. We also obtained permission from the facility heads. comorbidities along with living with HIV:
‘What we have also done is now all the patients, because we
Results provide a holistic, integrated service in this department, we
have made a chronic club [patients with concomitant HIV and
The findings are presented in relation to the two initial non-infectious chronic diseases]. We have three chronic clubs.
programme theories. If you have hypertension or diabetes, then we will put you
together in one club. So, we know when those patients come,
Qualitative findings we measure their blood pressures, we will test their sugar
Context levels, and we will send them for their yearly eye testing.
We also do their feet exam, so that they are also not
Context relates to important conditions relevant to the disadvantaged.’ (Nurse 1, female)
implementation of the adherence club, which includes buy-in
from health workers, clinic organisation, the number of clubs Availability of conducive physical space
run by the facility, staffing dynamics, availability of resources The availability of appropriate physical space where the
(including human resources), pre-club preparations (including adherence club sessions could be conducted is an important
teamwork) done by the club team and individual patients’ context condition. In fact, the lack of a physical structure
attributes.
was one of the main reasons why the adherence club
programme at Facility Y only commenced in 2014 when a
Buy-in from health workers makeshift building was constructed. Some of the providers
Although buy-in could be identified as an important suggested that having a separate unit to run the adherence
mechanism for the implementation of the adherence club club programme is ideal. This was confirmed by the comments
intervention, it also constitutes an important context element of the adherence club nurse who suggested that having a
for its day-to-day functioning. Our analysis revealed that buy- separate, dedicated space for ART adherence clubs provides
in was not always obtained from all the operational managers an air of privacy for the patients:
when the programme was initially rolled out in the facility.
One of the counsellors explained the situation below: ‘We have a separate space at the back for club activities.
So, they have got their own privacy and their own space.
‘When the idea of clubs came in 2011, we did not like the idea They have that freedom and it is not with everybody else.’
because we knew that it would be more work for us. It meant (Nurse 1, female)
that we had to do our normal patient counselling including the
TB patients and then still organise the clubs. We were not happy Availability of a programme champion
about it … But when sister came, she explained that the clubs
will reduce the waiting times of the patients because we were A champion is someone who is dedicated to the success of
always complaining “we were working so slow, the time periods, a programme and closely monitors the implementation
waiting periods is long”.’ (Counsellor 2, female) and execution of every aspect of the programme. Having a

http://www.sajhivmed.org.za 153 Open Access