Retention in care and factors critical for effectively implementing antiretroviral adherence clubs in a rural district in South Africa
Date
2019-09-03
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley Open Access
Abstract
Introduction: Differentiated models of care that include referral of antiretroviral treatment (ART) clients to adherence clubs
are an important strategy to help clinics manage increased number of clients living with HIV in resource-constrained settings.
This study reported on (i) clinical outcomes among ART clients attending community-based adherence clubs and (ii) experiences
of adherence clubs and perceptions of factors key to successful adherence club implementation among clients and
healthcare workers.
Methods: A retrospective cohort analysis of routine data and a descriptive analysis of data collected through self-administered
surveys completed by clients and healthcare workers were completed. Clients starting ART at the study clinic, between
January 2014 and December 2015, were included in the cohort analysis and followed up until December 2016. The survey
data were collected from August to September 2017. The primary outcome for the cohort analysis was a comparison of loss
to follow-up (LTFU) between clients staying in clinic care and those referred to adherence clubs. Survey data reported on client
experiences of and healthcare worker perceptions of adherence club care.
Results: Cohort analysis reported on 465 participants, median baseline CD4 count 374 (IQR: 234 to 532) cells/ll and median
follow-up time 20.7 (IQR 14.1 to 27.7) months. Overall, 202 (43.4%) participants were referred to an adherence club. LTFU
was lower in those attending an adherence club (aHR =0.25, 95% CI: 0.11 to 0.56). This finding was confirmed on analysis
restricted to those eligible for adherence club referral (aHR =0.28, 95% CI: 0.12 to 0.65). Factors highlighted as associated
with successful adherence club implementation included: (i) referral of stable clients to the club, (ii) an ideal club size of ≥20
members, (iii) club services led by a counsellor (iv) using churches or community halls as venues (v) effective communication
between all parties, and (vi) timely delivery of prepacked medication.
Conclusions: This study showed good clinical outcomes, positive patient experiences and healthcare worker perceptions of
the adherence club model. Factors associated with successful adherence club implementation, highlighted in this study, can be
used to guide implementers in the scale-up of adherence club services across varied high-burden settings.
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Description
CITATION: Bock, P., et al. 2019. Retention in care and factors critical for effectively implementing antiretroviral adherence clubs in a rural district in South Africa. Journal of the International AIDS Society, 22(10):e25396, doi:10.1002/jia2.25396.
The original publication is available at https://onlinelibrary.wiley.com
Publication of this article was funded by the Stellenbosch University Open Access Fund
The original publication is available at https://onlinelibrary.wiley.com
Publication of this article was funded by the Stellenbosch University Open Access Fund
Keywords
Antiretroviral agents, Patient compliance, HIV-positive persons -- Treatment compliance, HIV infections -- Treatment
Citation
Bock, P., et al. 2019. Retention in care and factors critical for effectively implementing antiretroviral adherence clubs in a rural district in South Africa. Journal of the International AIDS Society, 22(10):e25396, doi:10.1002/jia2.25396