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Acceptability of community-based adherence clubs among health facility staff in South Africa: a qualitative study

机译：南非卫生机构工作人员对社区依从性俱乐部的接受度：定性研究

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Background: Patient retention in care for HIV/AIDS is a critical challenge for antiretroviral treatment programs. Community-based adherence programs (CBAPs) as compared to health care facility-based adherence programs have been considered as one of the options to provide treatment maintenance support for groups of patients on antiretroviral therapy. Such an approach provides a way of enhancing self-management of the patient’s condition. In addition, CBAPs have been implemented to support antiretroviral treatment expansion in resource-limited settings. CBAPs involve 30 patients that are allocated to a group and meet at either a facility or a community venue for less than an hour every 2 or 3 months depending on the supply of medication. Our study aimed to establish perceived challenges in moving adherence clubs from health facilities to communities. Methods: A qualitative study was conducted in 39 clinics in Mpumalanga and Gauteng Provinces in South Africa between December 2015 and January 2016. Purposive sampling methods was used to identify nurses, club managers, data capturers, pharmacists and pharmacy assistants who had been involved in facility-based treatment adherence clubs. Key-informant interviews were conducted. Also, semi-structured interviews were used and thematic content analysis was done. Results: A total of 53 health care workers, 12 (22.6%) males and 41 (77.4%) females, participated in the study. Most of them 49 (92.5%) indicated that participating in community adherence clubs were a good idea. Reduction in waiting time at the health facilities, in defaulter rate, improvement in adherence to treatment as well as reduction in stigma were some of the perceived benefits. However, security of medication, storage conditions and transportation of the prepacked medication to the distribution sites were the areas of concern. Conclusion: Health care workers were agreeable to idea of the moving adherence clubs from health facilities to communities. Although some challenges were identified, these could be addressed by the key stakeholders. However, government and nongovernmental organizations need to exercise caution when transitioning to community-based adherence clubs.
机译：背景：将患者留在艾滋病毒/艾滋病的护理中是抗逆转录病毒治疗计划的一项关键挑战。与基于医疗机构的依从性计划相比，基于社区的依从性计划（CBAP）被认为是为接受抗逆转录病毒治疗的患者群体提供治疗维持支持的一种选择。这种方法提供了一种增强对患者状况的自我管理的方法。此外，已实施CBAP以支持在资源有限的环境中扩展抗逆转录病毒治疗。 CBAP涉及30位患者，这些患者被分配到一个小组中，并根据药物的供应情况每2个月或3个月在设施或社区场所开会少于一小时。我们的研究旨在确定将依从性俱乐部从医疗机构迁移到社区时所面临的挑战。方法：于2015年12月至2016年1月之间，在南非姆普马兰加省和豪登省的39家诊所进行了定性研究。采用目的抽样方法来确定参与设施的护士，俱乐部经理，数据采集者，药师和药房助理为主的治疗依从性俱乐部。进行了关键信息访谈。此外，使用了半结构化访谈并进行了主题内容分析。结果：共有53名医护人员参加，其中男性12名（22.6％）和女性41名（77.4％）。其中大多数（49.5％）表示参加社区遵守俱乐部是个好主意。减少医疗机构的等待时间，降低违约率，改善对治疗的依从性以及减少耻辱感是一些可以感觉到的好处。但是，药品的安全性，存储条件以及预包装药品到分发地点的运输是值得关注的领域。结论：医护人员同意将依从性俱乐部从医疗机构转移到社区的想法。尽管确定了一些挑战，但关键的利益相关者可以解决这些挑战。但是，政府和非政府组织在过渡到社区依从性俱乐部时需要谨慎行事。

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