School of Public Health, University of the Western Cape, Cape Town, South Africa.
Health Res Policy Syst. 2019 Mar 14;17(1):28. doi: 10.1186/s12961-019-0428-z.
The successful initiation of people living with HIV on antiretroviral treatment (ART) in South Africa fomented challenges of poor retention in care and suboptimal adherence to medication. Following evidence of the potential of adherence clubs (ACs) to improve patient retention in ART and adherence to medication, the South African National Department of Health drafted a policy in 2016 encouraging the rollout of ACs nationwide. However, little guidance on the rollout strategy has been provided to date, and the national adoption status of the AC programme is unclear. To this end, we aimed to review the effectiveness of the rollout of the antiretroviral AC intervention in South Africa to date through an implementation research framework.
We utilised a deductive thematic analysis of documents of the AC programme in South Africa obtained from searching various databases from December 2017 to July 2018. The implementation outcome variables (acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, coverage and sustainability) were applied to frame and describe the effectiveness of the national rollout of the AC programme in South Africa.
We identified 32 eligible documents that were included for analysis. Our analysis showed that ACs were highly acceptable by patients and health stakeholders given the observed benefits, including decongestion of clinics, increased social support for patients and the low cost of implementation. Evidence suggests that the AC model proved to be effective in improving adherence to ART and retention in care. Based on the success of ACs in the Western Cape, ACs are currently being implemented in all of the other South African provinces.
The inherent adaptability of the AC model should allow innovative strategies to maximise the use of existing resources. Therefore, the challenge is not limited to acquiring additional resources and support, but also includes the efficient use of available resources. Emerging challenges with AC programmes need to be addressed by increasing communication between stakeholders and fostering a culture of learning between facilities. As the AC programme expands and adapts to accommodate more people living with HIV and different population groups, policies should be designed to overcome present and anticipated challenges to enable its success.
在南非，成功启动艾滋病毒感染者的抗逆转录病毒治疗（ART）引发了患者在护理中保留率低和药物依从性差的挑战。在发现坚持治疗俱乐部（AC）有可能提高接受 ART 治疗的患者保留率和药物依从性后，南非国家卫生部于 2016 年制定了一项政策，鼓励在全国范围内推广 AC。然而，迄今为止，几乎没有提供有关推出策略的指导，而且全国对 AC 方案的采用情况尚不清楚。为此，我们旨在通过实施研究框架审查南非抗逆转录病毒 AC 干预措施的推出效果。
我们从 2017 年 12 月至 2018 年 7 月，通过搜索各种数据库，对南非 AC 方案的文件进行了演绎主题分析。将实施结果变量（可接受性、适宜性、采用、可行性、保真度、实施成本、覆盖率和可持续性）应用于框架，以描述南非 AC 方案的全国推广效果。
我们确定了 32 份符合条件的文件，对其进行了分析。我们的分析表明，AC 得到了患者和卫生利益相关者的高度认可，因为观察到了一些益处，包括诊所拥堵情况的缓解、患者获得更多的社会支持以及实施成本较低。有证据表明，AC 模式在提高 ART 依从性和保留护理方面是有效的。基于在西开普省取得的成功，AC 目前正在南非的所有其他省份实施。
AC 模式的固有适应性应允许采用创新战略来最大限度地利用现有资源。因此，挑战不仅在于获取额外的资源和支持，还在于有效利用现有资源。需要通过加强利益相关者之间的沟通以及促进设施之间的学习文化，来解决 AC 方案出现的新挑战。随着 AC 方案的扩大和适应，以容纳更多的艾滋病毒感染者和不同人群，应设计政策来克服当前和预期的挑战，以确保其成功。
