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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

Ferdinand C. Mukumbang, B. Marchal, S. Van Belle, B. van Wyk
Published 2018 · Medicine

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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.
This paper references
10.1080/13548506.2014.953962
Experiences of participating in an antiretroviral treatment adherence club
Raashika Dudhia (2015)
Why would antiretroviral treatment adherence clubs work in the Western Cape Province, South Africa?
Ferdinand C. Mukumbang (2017)
10.1057/palgrave.jors.2601980
A critique of statistical modelling in management science from a critical realist perspective: its role within multimethodology
J. Mingers (2006)
10.1177/1356389005053198
Using Realistic Evaluation to Evaluate a Practice-level Intervention to Improve Primary Healthcare for Patients with Long-term Mental Illness
R. Byng (2005)
10.1093/ACPROF:OSO/9780199563623.001.0001
Built environment: walkability of neighbourhoods
K. Gebel (2009)
10.7196/samj.6666
MSF again paves the way with ART.
C. Bateman (2013)
10.1371/journal.pone.0056088
Effectiveness of Patient Adherence Groups as a Model of Care for Stable Patients on Antiretroviral Therapy in Khayelitsha, Cape Town, South Africa
M. Luque-Fernandez (2013)
10.1136/bmjgh-2019-001638
Realist evaluations in low- and middle-income countries: reflections and recommendations from the experiences of a foreign researcher
B. Gilmore (2019)
10.17169/FQS-9.1.334
Cultivating the Under-Mined: Cross-Case Analysis as Knowledge Mobilization
S. Khan (2008)
10.1093/eurpub/ckr084
When are complex interventions 'complex'? When are simple interventions 'simple'?
M. Petticrew (2011)
10.1136/bmjgh-2016-000181
Towards an agenda for implementation science in global health: there is nothing more practical than good (social science) theories
S. Van Belle (2017)
A realist evaluation of the antiretroviral treatment adherence clubprogramme in the metropolitan area of the Western Cape Province,South Africa
Ferdinand C. Mukumbang (2018)
Free Press; 1968
Merton RK. Social theory (2018)
10.1093/ACPROF:OSO/9780199563623.003.04
Theory-driven evaluation of public health programmes
R. Pawson (2009)
SAGE Publications; 2014
Yin R. Case Study Research. Design (2018)
10.1186/s13012-017-0638-0
An exploration of group-based HIV/AIDS treatment and care models in Sub-Saharan Africa using a realist evaluation (Intervention-Context-Actor-Mechanism-Outcome) heuristic tool: a systematic review
Ferdinand C. Mukumbang (2017)
10.1186/s12913-016-1836-1
Public accountability needs to be enforced –a case study of the governance arrangements and accountability practices in a rural health district in Ghana
S. Van Belle (2016)
10.4102/SAJHIVMED.V14I2.77
ART adherence clubs: A long-term retention strategy for clinically stable patients receiving antiretroviral therapy
L. Wilkinson (2013)
10.1186/2193-1801-3-12
Realist explanatory theory building method for social epidemiology: a protocol for a mixed method multilevel study of neighbourhood context and postnatal depression
John G Eastwood (2014)
10.1056/NEJMp1414213
Treating millions for HIV--the adherence clubs of Khayelitsha.
Edward W. Campion (2015)
10.1371/journal.pone.0164634
"They just come, pick and go." The Acceptability of Integrated Medication Adherence Clubs for HIV and Non Communicable Disease (NCD) Patients in Kibera, Kenya
E. Venables (2016)
10.1093/INTQHC/6.2.115
Single and combined strategies for implementing changes in primary care: a literature review.
M. Wensing (1994)
10.1080/08870446.2014.953530
Evaluating complex interventions: Perspectives and issues for health behaviour change interventions
Cyril Tarquinio (2015)
10.1371/journal.pone.0161790
Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa
Ferdinand C. Mukumbang (2016)
10.1007/s11904-019-00454-5
A Review of Differentiated Service Delivery for HIV Treatment: Effectiveness, Mechanisms, Targeting, and Scale
M. Roy (2019)
10.4102/sajhivmed.v20i1.922
‘At this [adherence] club, we are a family now’: A realist theory-testing case study of the antiretroviral treatment adherence club, South Africa
Ferdinand C. Mukumbang (2019)
10.1177/0049124116644273
Case Study Research
Colin Elman (2016)
10.1186/s12916-016-0643-1
RAMESES II reporting standards for realist evaluations
G. Wong (2016)
10.7448/IAS.20.5.21649
High rates of retention and viral suppression in the scale-up of antiretroviral therapy adherence clubs in Cape Town, South Africa
P. Tsondai (2017)
10.1007/s41184-019-0055-8
Realist Evaluation
Pieterbas Lalleman (2019)
10.9745/GHSP-D-19-00012
Operationalizing Integrated Immunization and Family Planning Services in Rural Liberia: Lessons Learned From Evaluating Service Quality and Utilization
Allyson R. Nelson (2019)
Mid-year population estimates
S A Stats (2017)
British Cabinet Office
R Pawson
10.1136/bmjopen-2015-009977
Realist evaluation of the antiretroviral treatment adherence club programme in selected primary healthcare facilities in the metropolitan area of Western Cape Province, South Africa: a study protocol
Ferdinand C. Mukumbang (2016)
10.1177/1356389012442444
Is realist evaluation keeping its promise? A review of published empirical studies in the field of health systems research
B. Marchal (2012)
10.1016/j.soscij.2003.10.017
Realistic Evaluation
Fadhel Kaboub (2004)
10.7448/IAS.18.1.19984
Implementation of community-based adherence clubs for stable antiretroviral therapy patients in Cape Town, South Africa
A. Grimsrud (2015)
What are Social Mechanisms
Li Jun-peng (2012)
Mid-year population estimates 2017
SA Stats
10.1111/TMI.12978
Cluster randomised trial and development of a sandfly sex pheromone lure to reduce Leishmania infantum infection
O. Courtenay (2017)
10.7448/IAS.20.5.21650
Multi-month prescriptions, fast-track refills, and community ART groups: results from a process evaluation in Malawi on using differentiated models of care to achieve national HIV treatment goals
Margaret L Prust (2017)
10.1177/1356389012440912
A realist diagnostic workshop
R. Pawson (2012)
10.7448/IAS.17.1.18910
Sustainability of a community-based anti-retroviral care delivery model – a qualitative research study in Tete, Mozambique
F. Rasschaert (2014)
10.7448/IAS.16.1.17978
A qualitative study of community home-based care and antiretroviral adherence in Swaziland
R. Root (2013)
10.7448/IAS.19.1.21484
Reimagining HIV service delivery: the role of differentiated care from prevention to suppression
A. Grimsrud (2016)
Accountability in sexual and reproductive health How relations between INGOs and state actors shape public accountability A study of two local health systems in Ghana
SH VanBelleS.Mayhew (2016)
Case Study Research: Putting the Quant Into the
C Elman (2016)
10.1136/bmjopen-2019-029745
Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilisation in two South African provinces: a realist evaluation protocol
Eveline M Kabongo (2019)
Case Study Research Design And Methods
Christine Nadel (2016)
10.2307/2390803
Social Theory and Social Structure
R. Merton (1949)
10.1186/s12889-017-4322-8
Exploring ‘generative mechanisms’ of the antiretroviral adherence club intervention using the realist approach: a scoping review of research-based antiretroviral treatment adherence theories
Ferdinand C. Mukumbang (2017)
10.1371/journal.pone.0091544
A Qualitative Assessment of a Community Antiretroviral Therapy Group Model in Tete, Mozambique
F. Rasschaert (2014)



This paper is referenced by
10.34172/IJHPM.2020.32
Leaving No Man Behind: How Differentiated Service Delivery Models Increase Men's Engagement in HIV Care.
Ferdinand C. Mukumbang (2020)
10.1371/journal.pone.0210565
Unravelling how and why the Antiretroviral Adherence Club Intervention works (or not) in a public health facility: A realist explanatory theory-building case study
Ferdinand C. Mukumbang (2019)
10.1186/s12961-019-0428-z
What do the implementation outcome variables tell us about the scaling-up of the antiretroviral treatment adherence clubs in South Africa? A document review
Ferdinand C. Mukumbang (2019)
10.4102/sajhivmed.v20i1.922
‘At this [adherence] club, we are a family now’: A realist theory-testing case study of the antiretroviral treatment adherence club, South Africa
Ferdinand C. Mukumbang (2019)
10.1136/bmjgh-2019-001638
Realist evaluations in low- and middle-income countries: reflections and recommendations from the experiences of a foreign researcher
B. Gilmore (2019)
10.1136/bmjopen-2020-037224
Exploring and understanding the scope and value of the Parkinson’s nurse in the UK (The USP Project): a realist economic evaluation protocol
S. Brown (2020)
10.1186/s12874-018-0503-0
A realist approach to eliciting the initial programme theory of the antiretroviral treatment adherence club intervention in the Western Cape Province, South Africa
Ferdinand C. Mukumbang (2018)
10.1007/s11904-019-00454-5
A Review of Differentiated Service Delivery for HIV Treatment: Effectiveness, Mechanisms, Targeting, and Scale
M. Roy (2019)
10.9745/GHSP-D-19-00012
Operationalizing Integrated Immunization and Family Planning Services in Rural Liberia: Lessons Learned From Evaluating Service Quality and Utilization
Allyson R. Nelson (2019)
10.12688/wellcomeopenres.16379.2
Programme theory and linked intervention strategy for large-scale change to improve hospital care in a low and middle-income country - A Study Pre-Protocol
M. English (2020)
10.1177/1049732318784883
“Patients Are Not Following the [Adherence] Club Rules Anymore”: A Realist Case Study of the Antiretroviral Treatment Adherence Club, South Africa
Ferdinand C. Mukumbang (2018)
10.1136/bmjopen-2019-029745
Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilisation in two South African provinces: a realist evaluation protocol
Eveline M Kabongo (2019)
10.1007/978-3-030-43306-2_88
Fitness Club Customer Body Condition Detection System Based on Internet of Things
Younan Yi (2020)
10.1111/tmi.13490
Outcomes of patients on second‐ and third‐line ART enrolled in ART adherence clubs in Maputo, Mozambique
I. Finci (2020)
10.3167/AIA.2019.260105
Global Health Research, Anthropology and Realist Enquiry: Methodological Musings
S. V. Belle (2019)
10.1177/1609406920938577
What’s in a Realist Configuration? Deciding Which Causal Configurations to Use, How, and Why
E. de Weger (2020)
10.1177/1468794119881985
Using the realist interview approach to maintain theoretical awareness in realist studies
Ferdinand C. Mukumbang (2020)
10.12688/wellcomeopenres.16379.1
Programme theory and linked intervention strategy for large-scale change to improve hospital care in a low and middle-income country - A Study Pre-Protocol.
M. English (2020)
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