ArticleBMC health services research2018
Unearthing how, why, for whom and under what health system conditions the antiretroviral treatment adherence club intervention in South Africa works: A realist theory refining approach.
Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
46 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Antiretroviral Therapy Adherence Interventions in the Era of Universal Test and Treat: A Hybrid Systematic-Narrative Literature Review of Global Evidence.AIDS and behavior · 2026Pooled it
- Contextual success and pitfalls of mHealth service for maternal and child health in Africa: An Intervention, Context, Actors, Mechanism, and Outcome (ICAMO) framework guided systematic review of qualitative evidence.BMC pregnancy and childbirth · 2024Pooled it
- Trial
- Sustainability capacity and health worker normalisation of a successful non-communicable disease (NCD) health systems intervention within primary care settings in Uganda: a quantitative approach to a qualitative question.BMC health services research · 2023Trial
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- Realist Collaborative Evaluation of a Work Disability Prevention Program for Breast Cancer Survivors: Protocol for a RECOVA-FASTRACS Realist Evaluation.JMIR research protocols · 2026Article
- Implementing women's sexual and reproductive health interventions in prisons: a realist review.BMJ open · 2026Review
- Effectiveness, mechanisms, implementation, and cost-offset of an intersectoral prevention program targeting youth mental health difficulties: the STIME study protocol.BMC public health · 2026Article
- How does a video feedback intervention work for people with dementia and distress behaviour living in a nursing home, for whom and under which circumstances? A realist interview study.International journal of nursing studies advances · 2026Article
- Context, mechanisms, and outcomes of smoke-free school hours in social and health care vocational schools: a realist informed qualitative analysis.BMC public health · 2026Article
- Co-Designing Local Collaboration Between Social Services, Primary Healthcare, and the Third Sector-A Realist Process Evaluation.Health expectations : an international journal of public participation in health care and health policy · 2026Article
- Understanding how a national clinical audit is established, maintained and sustained using the Irish Hip Fracture Database as an exemplar: a realist evaluation protocol.HRB open research · 2026Article
- Article
- Understanding the conditions for inclusive education: A realist evaluation of a French territorial innovation.PloS one · 2026Article
- Developing community-based programme theories to address unmet needs of people experiencing homelessness and severe mental illness: protocol for a realist review.NIHR open research · 2026Article
- Understanding fathers' responses to breastfeeding as a "shared parental task": a realist evaluation of a Danish breastfeeding support intervention.Archives of public health = Archives belges de sante publique · 2025Article
- When the parts are greater than the whole: how understanding mechanisms can advance implementation research.Implementation science : IS · 2025Article
- Empowerment as a key mechanism for supporting changes in eating behaviors among disadvantaged immigrant women living with diabetes, obesity or hypertension: a realistic evaluation.Archives of public health = Archives belges de sante publique · 2025Article
- A Realist Scoping Review of Community Nutrition Interventions in the UK: Implications for the 'Nutrition Skills for Life' Programme.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2025Article
- Adherence to antiretroviral therapy among female sex workers in Kampala, Uganda.Journal of public health in Africa · 2025Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPoor retention in care and suboptimal adherence to antiretroviral treatment (ART) undermine its successful rollout in South Africa. The adherence club intervention was designed as an adherence-enhancing intervention to enhance the retention in care of patients on ART and their adherence to medication. Although empirical evidence suggests the effective superiority of the adherence club intervention to standard clinic ART care schemes, it is poorly understood exactly how and why it works, and under what health system contexts. To this end, we aimed to develop a refined programme theory explicating how, why, for whom and under what health system contexts the adherence club intervention works (or not).
methodsWe undertook a realist evaluation study to uncover the programme theory of the adherence club intervention. We elicited an initial programme theory of the adherence club intervention and tested the initial programme theory in three contrastive sites. Using a cross-case analysis approach, we delineated the conceptualisation of the intervention, context, actor and mechanism components of the three contrastive cases to explain the outcomes of the adherence club intervention, guided by retroductive inferencing.
resultsWe found that an intervention that groups clinically stable patients on ART in a convenient space to receive a quick and uninterrupted supply of medication, health talks, counselling, and immediate access to a clinician when required works because patients' self-efficacy improves and they become motivated and nudged to remain in care and adhere to medication. The successful implementation and rollout of the adherence club intervention are contingent on the separation of the adherence club programme from other patients who are HIV-negative. In addition, there should be available convenient space for the adherence club meetings, continuous support of the adherence club facilitators by clinicians and buy-in from the health workers at the health-care facility and the community.
conclusionUnderstanding what aspects of antiretroviral club intervention works, for what sections of the patient population, and under which community and health systems contexts, could inform guidelines for effective implementation in different contexts and scaling up of the intervention to improve population-level ART adherence.
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