Table 1.
Comparison of control and intervention arms.
| General Adult ART Clinic (Control) | Adherence Club (Intervention) | |
|---|---|---|
| Venue | ART clinic at the Gugulethu CHC | Offsite community hall, ~450 m from the CHC |
| Modality of care | Individualised | Group-based |
| Usual eligibility criteria | All patients eligible | On ART > 6 months, latest VL < 400 copies/ml, no comorbidities requiring regular clinical follow-up |
| First appointment date | Patients with a referral letter can attend on any day; appointment not necessary | Patients must attend the club office at the Gugulethu CHC with clinic folder and referral letter - CHW will provide first AC visit date |
| Attending staff | Clinician (CNP or doctor) | CHWs attend all club visits, CNP attends 2 club visits per year (blood visit and clinical visit) |
| Prescription frequency | 1-2 monthly, may be more frequent based on clinician discretion | 2 monthly |
| End of year holiday arrangements | 3 months of ART for stable patients from mid-October | 4 months of ART for all patients from beginning of October |
| Treatment buddy collections | Buddies may collect medication on behalf of the patient unless clinician requests to see the patient | Buddies may collect medication on behalf of the patient on alternate visits, but blood and clinical visits must be attended by the patient |
| Counselling | Daily waiting room CHW talks, patients at high risk for non-adherence have pill counts and further counselling | Group counselling session at every visit |
| Laboratory testing | Months 4 and 12 on ART and then annually, may be more frequent based on clinician discretion | Annually |
| Visit duration | From 3 to 4 h to the whole day | ~1 h for standard visit, up to 3 h for clinical visit |
| Follow-up of non-attendance | Every 4 months, patients who have not had an ART refill in this period have a home visit by a CHW | If medication not collected within 5 days of scheduled AC visit, participant referred to the general adult ART clinic |
| Management of clinical complications or VL > 400 copies/ml | Managed by CHC clinicians, with up-referral if necessary | Referred to general adult ART clinic for further management |
| Provision of routine infant care | Local “well-baby” clinic | Local “well-baby” clinic |
AC: Adherence club; ART: Antiretroviral therapy; CHC: Community health centre, CHW: Community health worker; CNP: Clinical nurse practitioner; h: Hour; VL: Viral load.