|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.|
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.|