A comparative evaluation of the successes and challenges of the antiretroviral therapy adherence clubs in the Helderberg District of the Western Cape Province, South Africa
Thesis (MFamMed)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Aims and objectives: To perform a comparative evaluation of the successes and challenges of the anti-retroviral therapy (ART) adherence clubs in the Helderberg District of the Western Cape Province. Methods: Phase 1: A retrospective review of patient records, comparing a group of patients enrolled in the ART adherence clubs with a pre-enrollment group. Outcome measures were CD4, viral load (VL), opportunistic infections and HIV-related hospital admissions. Statistical analysis with Statistica Version 11. Phase 2: A qualitative exploration of the views and experiences of patients and health care providers on the efficiency and patient-friendliness of the adherence club system. Results: Phase 1: The files of 281 patients were compared for measurable outcomes of ART. Despite the median baseline CD4 being higher and the median time on treatment being lower in the pre-enrollment group, opportunistic infections were more common in the pre-enrollment group, and there were more detectable VLs (p< 0.05; Pearson Chi- square; Mann- Whitney U- test). Phase 2: Focus group discussions and interviews were conducted with 93 patients and 6 staff members. ART clubs were generally felt to be efficient, accessible, convenient, patient-friendly, supportive, accommodating of the needs of working people, as well as decreasing the workload of the ART clinic and hospital pharmacy. Participants identified several problems, namely inadequate medical- and counseling support, poor documentation, logistical issues with the chronic dispensing unit (CDU), fragmentation of clinical services, and the high administrative load on clinicians. Recommendations made by participants on how problems in the system can be addressed include the appointment of more non-clinical staff, providing opportunities for staff training, scheduling regular doctor visits, providing ongoing adherence support, performing regular audits, digitalizing scripts, addressing logistical- and flow management issues, and the integration of ART with other clinical services. Conclusion: ART adherence clubs benefit both the patients enrolled and the greater health system. Their ability to improve HIV treatment outcomes in the study setting supports the expansion of the club programme, as well as its exploration as a model for the management of other chronic diseases.
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