"Patients are not following the [adherence] club rules anymore": a realist case study of the antiretroviral rreatment adherence club, South Africa

Ferdinand C Mukumbang, Bruno Marchal, Sara Van Belle, Brian van Wyk

Research output: Contribution to journalA1: Web of Science-article

Abstract

There is growing evidence that differentiated care models employed to manage treatment-experienced patients on antiretroviral therapy could improve adherence to medication and retention in care. We conducted a realist evaluation to determine how, why, for whom, and under what health system context the adherence club intervention works (or not) in real-life implementation. In the first phase, we developed an initial program theory of the adherence club intervention. In this study, we report on an explanatory theory-testing case study to test the initial theory. We conducted a retrospective cohort analysis and an explanatory qualitative study to gain insights into the important mechanisms activated by the adherence club intervention and the relevant context conditions that trigger the different mechanisms to achieve the observed outcomes. This study identified potential mitigating circumstances under which the adherence club program could be implemented, which could inform the rollout and implementation of the adherence club intervention.

Original languageEnglish
JournalQualitative Health Research
Volume28
Issue number12
Pages (from-to)1839-1857
Number of pages19
ISSN1049-7323
DOIs
Publication statusPublished - 2018

Keywords

  • adherence
  • adherence club
  • antiretroviral therapy
  • configurational mapping
  • intervention-context-actor-mechanism-outcome configuration
  • generative mechanisms
  • program theory
  • realist evaluation
  • retention in care
  • retroduction
  • mixed-methods
  • South Africa
  • MEDICATION ADHERENCE
  • THERAPY PATIENTS
  • STABLE PATIENTS
  • MECHANISMS
  • ART

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