Improving Retention and Viral Load Suppression Rates: Scale-Up of Adherence Clubs for Stable Antiretroviral Patients in Cape Town, South Africa

Description/Activities:  ACs meet either at a health care facility, or at a community-based venue for symptom screening, group discussions, ART distribution, and care and support to groups of stable patients (Tsondai et al., 2017).  Each AC is composed of approximately 25 to 30 patients who meet for 30 to 60 minutes five times per year to receive their pre-packed ART supply. This is a two-month supply, until year-end when they receive a four-month supply. Annually, both blood is drawn for viral-load (VL) monitoring at month four, and a clinical consultation occurs at month six. ACs are facilitated by lay health care workers (LHCWs) and usually supported by nurses, particularly for blood draws and clinical consults.  Thus, the ACs are initiated by, and connected with, specific health facilities.

What Makes the Intervention Unique/Different: ACs can reduce the burden that stable patients place on healthcare facilities, freeing healthcare workers to treat new and unstable patients. This innovative solution addresses congestion in health facilities caused by large volumes of patients, and provides more flexible and convenient services for stable patients.

Impact Data: 

  • Retention was 95.2% at 12 months and 89.3% at 24 months after AC enrollment.
  • In the 13 months prior to analysis closure, 88.1% of patients had VL assessments; of those, 97.2% were virally suppressed.
  • Significantly, risk of loss to follow up from ACs was higher in younger patients and patients accessing ART from facilities with larger ART cohorts. 
  • By March 2015, 55 of 70 health facilities providing ART services in Cape Town had ACs. 
  • Through March 2016, ACs have been further scaled up to reach approximately 32% of 142,000 patients on ART..