ArticlePloS one2019
Unravelling how and why the Antiretroviral Adherence Club Intervention works (or not) in a public health facility: A realist explanatory theory-building case study.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Exploring Sustainability in the Era of Differentiated HIV Service Delivery in Sub-Saharan Africa: A Systematic Review.Journal of acquired immune deficiency syndromes (1999) · 2021Pooled it
- 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
- Integrated mental health for refugees: A realist theory building study.PLOS mental health · 2026Article
- Mental health policy implementation in low- and middle-income countries: a realist review protocol.PloS one · 2025Article
- TRIPLE C reporting principles for case study evaluations of the role of context in complex interventions.BMC medical research methodology · 2023Review
- Article
- Comparing Patients' Experiences in Three Differentiated Service Delivery Models for HIV Treatment in South Africa.Qualitative health research · 2022Article
- A guide to systems-level, participatory, theory-informed implementation research in global health.BMJ global health · 2021Article
- Evaluating complex interventions in context: systematic, meta-narrative review of case study approaches.BMC medical research methodology · 2021Review
- Implementing 'universal' access to antiretroviral treatment in South Africa: a scoping review on research priorities.Health policy and planning · 2021Article
- Community Group-Based Models of Medication Delivery: Applicability to Cardiovascular Diseases.Global heart · 2021Review
- Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis.BMC pregnancy and childbirth · 2021Article
- Using implementation science theories and frameworks in global health.BMJ global health · 2020Review
- What do the implementation outcome variables tell us about the scaling-up of the antiretroviral treatment adherence clubs in South Africa? A document review.Health research policy and systems · 2019Review
- 'At this [Southern African journal of HIV medicine · 2019Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough empirical evidence suggests that the adherence club model is more effective in retaining people living with HIV in antiretroviral treatment care and sustaining medication adherence compared to standard clinic care, it is poorly understood exactly how and why this works. In this paper, we examined and made explicit how, why and for whom the adherence club model works at a public health facility in South Africa.
methodsWe applied an explanatory theory-building case study approach to examine the validity of an initial programme theory developed a priori. We collected data using a retrospective cohort quantitative design to describe the suppressive adherence and retention in care behaviours of patients on ART using Kaplan-Meier methods. In conjunction, we employed an explanatory qualitative study design using non-participant observations and realist interviews to gain insights into the important mechanisms activated by the adherence club intervention and the relevant contextual conditions that trigger the different mechanisms to cause the observed behaviours. We applied the retroduction logic to configure the intervention-context-actor-mechanism-outcome map to formulate generative theories.
resultsA modified programme theory involving targeted care for clinically stable adult patients (18 years+) receiving antiretroviral therapy was obtained. Targeted care involved receiving quick, uninterrupted supply of antiretroviral medication (with reduced clinic visit frequencies), health talks and counselling, immediate access to a clinician when required and guided by club rules and regulations within the context of adequate resources, and convenient (size and position) space and proper preparation by the club team. When grouped for targeted care, patients feel nudged, their self-efficacy is improved and they become motivated to adhere to their medication and remain in continuous care.
conclusionThis finding has implications for understanding how, why and under what health system conditions the adherence club intervention works to improve its rollout in other contexts.
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