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Adherence clubs and decentralized medication delivery to support patient retention and sustained viral suppression in care: Results from a cluster-randomized evaluation of differentiated ART delivery models in South Africa

Author

Listed:
  • Matthew P Fox
  • Sophie Pascoe
  • Amy N Huber
  • Joshua Murphy
  • Mokgadi Phokojoe
  • Marelize Gorgens
  • Sydney Rosen
  • David Wilson
  • Yogan Pillay
  • Nicole Fraser-Hurt

Abstract

Background: Differentiated antiretroviral therapy (ART) delivery models, in which patients are provided with care relevant to their current status (e.g., newly initiating, stable on treatment, or unstable on treatment) has become an essential part of patient-centered health systems. In 2015, the South African government implemented Chronic Disease Adherence Guidelines (AGLs), which involved five interventions: Fast Track Initiation Counseling for newly initiating patients, Enhanced Adherence Counseling for patients with an unsuppressed viral load, Early Tracing of patients who miss visits, and Adherence Clubs (ACs) and Decentralized Medication Delivery (DMD) for stable patients. We evaluated two of these interventions in 24 South African facilities: ACs, in which patients meet in groups outside usual clinic procedures and receive medication; and DMD, in which patients pick up their medication outside usual pharmacy queues. Methods and findings: We compared those participating in ACs or receiving DMD at intervention sites to those eligible for ACs or DMD at control sites. Outcomes were retention and sustained viral suppression (

Suggested Citation

  • Matthew P Fox & Sophie Pascoe & Amy N Huber & Joshua Murphy & Mokgadi Phokojoe & Marelize Gorgens & Sydney Rosen & David Wilson & Yogan Pillay & Nicole Fraser-Hurt, 2019. "Adherence clubs and decentralized medication delivery to support patient retention and sustained viral suppression in care: Results from a cluster-randomized evaluation of differentiated ART delivery ," PLOS Medicine, Public Library of Science, vol. 16(7), pages 1-21, July.
    • Handle: RePEc:plo:pmed00:1002874
    DOI: 10.1371/journal.pmed.1002874
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