‘Only twice a year’: a qualitative exploration of 6-month antiretroviral treatment refills in adherence clubs for people living with HIV in Khayelitsha, South Africa
Objective Longer intervals between routine clinic visits and medication refills are part of patient-centred, differentiated service delivery (DSD). They have been shown to improve patient outcomes as well as optimise health services—vital as ‘universal test-and-treat’ targets increase numbers of HIV...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/7/e037545.full |
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| author | Claire Marriott Keene Risa Hoffman Nompumelelo Zokufa Emilie C Venables Lynne Wilkinson Tali Cassidy Leigh Snyman Anna Grimsrud Jacqueline Voget Erin von der Heyden Siphokazi Zide-Ndzungu Vinayak Bhardwaj Petros Isaakidis |
| author_facet | Claire Marriott Keene Risa Hoffman Nompumelelo Zokufa Emilie C Venables Lynne Wilkinson Tali Cassidy Leigh Snyman Anna Grimsrud Jacqueline Voget Erin von der Heyden Siphokazi Zide-Ndzungu Vinayak Bhardwaj Petros Isaakidis |
| author_sort | Claire Marriott Keene |
| collection | DOAJ |
| description | Objective Longer intervals between routine clinic visits and medication refills are part of patient-centred, differentiated service delivery (DSD). They have been shown to improve patient outcomes as well as optimise health services—vital as ‘universal test-and-treat’ targets increase numbers of HIV patients on antiretroviral treatment (ART). This qualitative study explored patient, healthcare worker and key informant experiences and perceptions of extending ART refills to 6 months in adherence clubs in Khayelitsha, South Africa.Design and setting In-depth interviews were conducted in isiXhosa with purposively selected patients and in English with healthcare workers and key informants. All transcripts were audio-recorded, transcribed and translated to English, manually coded and thematically analysed. The participants had been involved in a randomised controlled trial evaluating multi-month ART dispensing in adherence clubs, comparing 6-month and 2-month refills.Participants Twenty-three patients, seven healthcare workers and six key informants.Results Patients found that 6-month refills increased convenience and reduced unintended disclosure. Contrary to key informant concerns about patients’ responsibility to manage larger quantities of ART, patients receiving 6-month refills were highly motivated and did not face challenges transporting, storing or adhering to treatment. All participant groups suggested that strict eligibility criteria were necessary for patients to realise the benefits of extended dispensing intervals. Six-month refills were felt to increase health system efficiency, but there were concerns about whether the existing drug supply system could adapt to 6-month refills on a larger scale.Conclusions Patients, healthcare workers and key informants found 6-month refills within adherence clubs acceptable and beneficial, but concerns were raised about the reliability of the supply chain to manage extended multi-month dispensing. Stepwise, slow expansion could avoid overstressing supply and allow time for the health system to adapt, permitting 6-month ART refills to enhance current DSD options to be more efficient and patient-centred within current health system constraints. |
| format | Article |
| id | doaj-art-d0c3aa004f2840d3b0bce85ca2a41ad0 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d0c3aa004f2840d3b0bce85ca2a41ad02025-08-20T02:18:36ZengBMJ Publishing GroupBMJ Open2044-60552020-07-0110710.1136/bmjopen-2020-037545‘Only twice a year’: a qualitative exploration of 6-month antiretroviral treatment refills in adherence clubs for people living with HIV in Khayelitsha, South AfricaClaire Marriott Keene0Risa Hoffman1Nompumelelo Zokufa2Emilie C Venables3Lynne Wilkinson4Tali Cassidy5Leigh Snyman6Anna Grimsrud7Jacqueline Voget8Erin von der Heyden9Siphokazi Zide-Ndzungu10Vinayak Bhardwaj11Petros Isaakidis126 NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UKDivision of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USAMédecins Sans Frontières South Africa, Cape Town, South AfricaSouthern Africa Medical Unit, Medecins Sans Frontieres South Africa, Cape Town, South AfricaInternational AIDS Society, Cape Town, South AfricaMédecins Sans Frontières South Africa, Cape Town, South AfricaMédecins Sans Frontières South Africa, Cape Town, South AfricaInternational AIDS Society, Cape Town, South AfricaWestern Cape Department of Health, Cape Town, South AfricaWestern Cape Department of Health, Cape Town, South AfricaWestern Cape Department of Health, Cape Town, South AfricaMédecins Sans Frontières South Africa, Cape Town, South AfricaSouthern Africa Medical Unit, Medecins Sans Frontieres South Africa, Cape Town, South AfricaObjective Longer intervals between routine clinic visits and medication refills are part of patient-centred, differentiated service delivery (DSD). They have been shown to improve patient outcomes as well as optimise health services—vital as ‘universal test-and-treat’ targets increase numbers of HIV patients on antiretroviral treatment (ART). This qualitative study explored patient, healthcare worker and key informant experiences and perceptions of extending ART refills to 6 months in adherence clubs in Khayelitsha, South Africa.Design and setting In-depth interviews were conducted in isiXhosa with purposively selected patients and in English with healthcare workers and key informants. All transcripts were audio-recorded, transcribed and translated to English, manually coded and thematically analysed. The participants had been involved in a randomised controlled trial evaluating multi-month ART dispensing in adherence clubs, comparing 6-month and 2-month refills.Participants Twenty-three patients, seven healthcare workers and six key informants.Results Patients found that 6-month refills increased convenience and reduced unintended disclosure. Contrary to key informant concerns about patients’ responsibility to manage larger quantities of ART, patients receiving 6-month refills were highly motivated and did not face challenges transporting, storing or adhering to treatment. All participant groups suggested that strict eligibility criteria were necessary for patients to realise the benefits of extended dispensing intervals. Six-month refills were felt to increase health system efficiency, but there were concerns about whether the existing drug supply system could adapt to 6-month refills on a larger scale.Conclusions Patients, healthcare workers and key informants found 6-month refills within adherence clubs acceptable and beneficial, but concerns were raised about the reliability of the supply chain to manage extended multi-month dispensing. Stepwise, slow expansion could avoid overstressing supply and allow time for the health system to adapt, permitting 6-month ART refills to enhance current DSD options to be more efficient and patient-centred within current health system constraints.https://bmjopen.bmj.com/content/10/7/e037545.full |
| spellingShingle | Claire Marriott Keene Risa Hoffman Nompumelelo Zokufa Emilie C Venables Lynne Wilkinson Tali Cassidy Leigh Snyman Anna Grimsrud Jacqueline Voget Erin von der Heyden Siphokazi Zide-Ndzungu Vinayak Bhardwaj Petros Isaakidis ‘Only twice a year’: a qualitative exploration of 6-month antiretroviral treatment refills in adherence clubs for people living with HIV in Khayelitsha, South Africa BMJ Open |
| title | ‘Only twice a year’: a qualitative exploration of 6-month antiretroviral treatment refills in adherence clubs for people living with HIV in Khayelitsha, South Africa |
| title_full | ‘Only twice a year’: a qualitative exploration of 6-month antiretroviral treatment refills in adherence clubs for people living with HIV in Khayelitsha, South Africa |
| title_fullStr | ‘Only twice a year’: a qualitative exploration of 6-month antiretroviral treatment refills in adherence clubs for people living with HIV in Khayelitsha, South Africa |
| title_full_unstemmed | ‘Only twice a year’: a qualitative exploration of 6-month antiretroviral treatment refills in adherence clubs for people living with HIV in Khayelitsha, South Africa |
| title_short | ‘Only twice a year’: a qualitative exploration of 6-month antiretroviral treatment refills in adherence clubs for people living with HIV in Khayelitsha, South Africa |
| title_sort | only twice a year a qualitative exploration of 6 month antiretroviral treatment refills in adherence clubs for people living with hiv in khayelitsha south africa |
| url | https://bmjopen.bmj.com/content/10/7/e037545.full |
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