Page 161 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 6 of 14 Original Research

programme champion is identified, therefore, as an important newly diagnosed patients who are not attending adherence
context element for the successful execution of the adherence clubs as they are not yet eligible to attend, but are aware of
club intervention. It triggers the required mechanisms to the benefits that the adherence club offers. One of the
ensure retention in care and adherence to medication. A counsellors indicated how patients are usually motivated to
participant said the following to capture the importance of join the adherence club for easy access to treatment and care
having a programme champion, especially with regard to by meeting the adherence club criterion of achieving viral
initiating and sustaining buy-in from other operational staff: load suppression:
‘When I came here, I received training and I wanted to find out ‘When we prepare them [treatment-naïve patients] for ARVs,
more about this club. I received training from an NGO and they we tell them “in six months if your viral load is suppressed
told us … what the goal of the club is, what is the aim, and then then you are going be a VIP which means starting from today
once I got the buy-in and the training, then I realised the benefits you are starting your medication, you need to take your
of it. I then encouraged my staff and told them “The more medication very well. You are not going to come to the clinic
patients we put in the club, the fewer patients we have to see”. monthly. You will come maybe four times but it will be less
Because the staff is always complaining, “There are many than five times a year to the clinic, we take blood only once a
patients”. They are overworked, they are exhausted, there are year.” You know so we are starting to buy them in when we
staff shortages, their morale is low and it is just too much. So, are preparing them. This motivates them to achieve a low
I said okay, I had several meetings with them. I said, “Guys, we viral load.’ (Counsellor 3, female)
need to pull together because we are not going to get more staff.
The only way to decongest the people waiting in our clinic is to
put them in a club because if they are in the club, we will have Perceived benefit
fewer people waiting here, fewer people that you have to see”. The perceived benefit relates to the awareness of the positive
So then, everybody was on board, everybody is excited and then impact that the resources of the adherence club could have on
we got a timetable. So, everybody was given a responsibility fitting their ART into their lifestyles. These benefits were
that we need to fill out the clubs, write out the scripts, fewer related to the prompt service delivery that they received
patients.’ (Nurse 1, female) through the adherence club. One of the patients expressed
their perceived benefit of having quick access to see a clinician
Teamwork when they have any issue(s) requiring clinician consultations.
Working as a team is identified as a favourable condition for This is expressed in the quote below:
the successful implementation and execution of the adherence ‘If you are here and you want to see the doctor, one of the nurses
club programme. This is related to the fact that each member goes inside and speaks to a doctor [on your behalf]. Then, they will
of the team has a role to play, and if any of the team members just come and fetch you here and then you go straight to the
fail to deliver, then the execution of the intervention is affected, doctor.’ (Patient 1, male)
which also affects how the users take up the intervention. One
of the counsellors explained how each of the operational staff Satisfaction
executing their responsibilities as a team member ensures that Satisfaction relates to the fulfilment of the patients’ desires,
the adherence club programme works seamlessly:
expectations and needs regarding the service delivery offered
‘Teamwork is very important because if the Sister [Nurse] does not through the adherence club. One of the patients expressed
prescribe the medication, you cannot get the medication from their satisfaction with the adherence club by indicating that it
Pharmacy, there are going to be delays or no medication given. is nice to have everything done within the club – a one-stop-
Then the patients have to go sit in that mainstream, then what is shop. This is how some of the patients described the care they
the use of the club because then they have to go back to the experienced in the club:
waiting area.’ (Counsellor 1, female)
‘Here we are doing everything inside here, so it is nice. It is very
nice. So, if someone wants to go back to work, she or he can go
Mechanisms back to work. So, it is encouraging for the person to take their
We identified possible mechanisms from the data, based on medication, it is encouraging for the person to come to the clinic.’
the two parts of the initial programme theory, and defined a (Patient 1, male)
‘mechanism’ as a process of how subjects interpret and act
upon the intervention. 19 According to the providers, the patients’ experiences with the
adherence club care leave them satisfied, which makes them
potentially remain in care and adhere to their medication.
Initial Programme Theory 1
Regarding Theory 1 (Box 1), we found the following elements Bonding and group identifying formation
in the interviews with the stakeholders. Bonding is the formation of a close relationship, especially
through frequent or constant association. The literature
Motivation says that the bonding process can be facilitated by shared
Motivation relates to the motive behind an individual’s common goals and characteristics. The bond formation
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involvement in an activity. In this case, the outcome of between the club members is an important mechanism as it
interest relates to ease of receiving ART and care services fosters sharing among the club patients. One of the patients
that fit into one’s lifestyle. This is especially applicable for explained how being in the club and meeting on a regular

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