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Table 5 A comparison of the adherence club intervention and the standard clinic ART service

From: A realist approach to eliciting the initial programme theory of the antiretroviral treatment adherence club intervention in the Western Cape Province, South Africa

Nature of service Standard clinic ART care Adherence club
Reception Patients queue at the waiting area to be seen by a clinician. The waiting times at larger facilities can be up to 4 h. Patients have an area reserved for them with a club facilitator at their disposal. They have scheduled times when the adherence club session starts.
Drug Dispensation Medications are provided by the clinic pharmacy, after the consultation with the clinician. The patient is expected to queue at the pharmacy waiting area for their medication to be served.
Patients receive one month’s supply of medication and possible two-month’s supply when the patient shows positive signs of adherence.
Medication is pre-packed by a central packaging and distribution centre, the Chronic Dispensing Unit, and distributed during the club session by the club facilitator.
Patients receive two month’s supply of medication. They can be given up to four month’s supply of medication during festive periods.
Blood sample collection Patients queue in front of the preparation room to be seen by a professional nurse so that blood can be drawn for routine CD4 and viral load measurements Patients in the adherence club have a professional nurse allocated to them, who prepares their laboratory forms and collects their blood samples at the set time. Members do not have to wait.
Attendance Frequency For each appointment, the patient is expected to be seen by a clinician for routine consultation and then by a lay counsellor for their drug accountability assessment and counselling. Patients are thus expected to attend in person at all times. Most of the activities at the adherence clubs are conducted by the lay counsellor and the patient is only expected to consult a clinician once a year except when the patient develops any opportunistic infection. Patients can send a ‘buddy’ to collect their medication and can only show up when it is time for their blood to be collected.
Accountability There is less accountability for these patients as they are not allocated to particular lay counsellors Better accountability and follow-up from the club facilitator as they feel responsible for the smooth running of their clubs and the patients in their clubs.