ArticleJournal of the International AIDS Society2019
Retention in care and factors critical for effectively implementing antiretroviral adherence clubs in a rural district in South Africa.
Article in Journal of the International AIDS Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 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
- Strategies for retention of heterosexual men in HIV care in sub-Saharan Africa: A systematic review.PloS one · 2021Pooled it
- Trial
- Twenty-four-month outcomes from a cluster-randomized controlled trial of extending antiretroviral therapy refills in ART adherence clubs.Journal of the International AIDS Society · 2020Trial
- Differentiated antiretroviral distribution: Implementation in five South African districts.African journal of primary health care & family medicine · 2025Article
- Barriers and facilitators to the implementation and scale up of differentiated service delivery models for HIV treatment in Africa: a scoping review.BMC health services research · 2022Article
- Using Intervention Mapping methodology to design an HIV linkage intervention in a refugee settlement in rural Uganda.AIDS care · 2022Article
- Beyond viral suppression: Quality of life among stable ART clients in a differentiated service delivery intervention in Tanzania.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2022Article
- Quality of care in a differentiated HIV service delivery intervention in Tanzania: A mixed-methods study.PloS one · 2022Article
- Experiences and Perceptions on Community Client-Led ART Delivery (CCLADS) Model of Antiretroviral (ART) Delivery: Patients' and Providers' Perspectives in South Western Uganda.HIV/AIDS (Auckland, N.Z.) · 2022Article
- Article
- Alternative mechanisms for delivery of medication in South Africa: A scoping review.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2021Article
- Patient-incurred costs in a differentiated service delivery club intervention compared to standard clinical care in Northwest Tanzania.Journal of the International AIDS Society · 2021Article
- Article
- "Patients are not the same, so we cannot treat them the same" - A qualitative content analysis of provider, patient and implementer perspectives on differentiated service delivery models for HIV treatment in South Africa.Journal of the International AIDS Society · 2020Article
- 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 · 2019Article
Corrections and comments
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Authors and funding
12 authors at 4 institutions in 2 countries.
Funding
Abstract
introductionDifferentiated 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.
methodsA 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.
resultsCohort analysis reported on 465 participants, median baseline CD4 count 374 (IQR: 234 to 532) cells/μl 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.
conclusionsThis 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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