A realist evaluation of the antiretroviral treatment adherence club programme in selected primary health care facilities in the metropolitan area of the Western Cape Province, South Africa

Project Details


Background: Retention in care and treatment adherence are key challenges to national antiretroviral therapy (ART) programmes in Sub-Saharan Africa. Innovative community-based approaches to HIV care and treatment have been proposed and implemented in several Sub- Saharan African countries to improve retention in care and adherence rates of patients on ART. One of such innovations, the „ART adherence club‟ was developed and piloted in the Western Cape Province of South Africa to improve retention in care and adherence among stable ART patients. Results from the pilot intervention showed that the retention in care and adherence to medication rates of these stable patients improved significantly. This resulted in the subsequent roll-out of ART adherence clubs in over 400 primary health care facilities by 2014 in the metro health district of the Western Cape Province. Today, an estimated 20% of all the patients in this region are currently receiving treatment in the adherence club care model. In consultation with programme managers, it was indicated that guidelines for the implementation the adherence care model need to be developed to implement the programme nationwide. Therefore, understanding how the adherence club initiative works within various contexts is crucial to adapting the intervention to new contexts in light of a possible rollout to the rest of South Africa. Aim: The aim of the study is to evaluate the implementation and effects of facility-based antiretroviral adherence clubs in the metro area of the Western Cape Province using the realist evaluation methodology.
Methods: In the first phase, an exploratory study, conducted through a document review process and key informant interviews will be used to elicit information to formulate the programme theory. In phase two, a multiple case study design will be used in which qualitative and quantitative data collection and analysis methods will be employed. In this phase, the actual data collection will be carried out on adherence clubs in five contrastive sites. In-depth inverviews will be conducted with purposively selected clinicians and patients for information on the context and mechanisms of the adherence clubs. For the programme‟s primary outcomes (retention in care and adherence), a longitudinal retrospective cohort analysis will be performed using routine patient data obtained from the provincial Department of Health. The data analysis will be conducted in two steps. First, coding the data and classifying the emerging themes using the context-mechanism-outcome (CMO) configuration analytic tools. Second, we will reduce the primitive CMO configurations to conjectured CMO configurations. The final phase, will entail comparing the conjectured context-mechanism-outcome configurations obtained from the second phase with the initial programme theory and refine this accordingly to obtain middle range theories.
Significance of study: The study‟s result will inform policymakers and programme managers in the Western Cape province in the scaling up programmes to increase retention in care and adherence to treatment.
Effective start/end date19/04/1615/02/18

IWETO expertise domain

  • B680-public-health


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