Table 1.

South Africa’s National Adherence Guidelines for Chronic Diseases: approach, interventions and standard of care for each patient groups

Target patient type	Adherence guideline (AGL) intervention [13]	Description of AGL intervention in study districts	Standard of care intervention	Description of standard of care in study districts
New patients: Newly testing and initiating treatment	Fast track treatment initiation counselling (FTIC)	Standardized education, counselling, and adherence support for newly diagnosed patients without delaying treatment initiation, and patient assistance to develop their own adherence plan. Patients initiate treatment after the first counselling session and complete remaining sessions at the first and second refill	2015 ART guidelines (NDOH) [13]; Universal Test and Treat (UTT) (from Sept 2016) [17]	Fast‐track initiation for certain patients based on health conditions including pregnant or breastfeeding women, or patients with CD4 ≤ 200 or stage 4 HIV; Start ART as soon patient is ready and within two weeks of CD4 count, regardless of CD4 result or HIV stage
Patients stable on treatment: Have initiated treatment and achieved viral load suppression (2 consecutive viral loads <400 copies/mL)	Repeat prescription collection strategies (RPCS)	Clinic‐based Adherence Clubs (AC): Patients receive medication and care during small group meetings (<30) conducted at the clinic or in the community every two months	Community‐based Adherence Clubs (AC) (Implemented as early as 2012) [21]	Implemented in some parts of the country via non‐governmental organizations. Patients receive medication and care during bi‐monthly small group meetings (<30) conducted at a clinic or in the community
		Decentralized medication delivery (DMD): Medications picked up at an external pick‐up‐point every two months	Decanting strategy (from May to June 2016) [14]	Promoted DMD and ACs in effort to decongest clinics. Included only the RPCS from the AGL; no formal launch. Rolled out at other non‐study sites within the study districts
		Spaced fast lane appointment systems (SFLA): Medication collected every two months from a dedicated fast‐lane pick‐up point at the facility with appointment for pick‐up date	2015 ART guidelines (NDOH) [13]	Support groups, SMS reminders, peer support worker, buddy system, community outreach with medication pick‐up at the facility
Patients not stable on treatment: Have initiated treatment and have an elevated viral load or missed scheduled clinic visit	Enhanced adherence counselling (EAC)	Enhanced adherence monitoring and targeted counselling interventions for those patients not stable on treatment (as defined by an elevated viral load) with timeous referral for support	2015 ART guidelines (NDOH) [13]	Increased counselling efforts, home visits, social support emphasis (buddy and support group), pill counts
	Early tracing of all missed appointments (TRIC)	Telephonic tracing and home visits by community health workers to trace patients who have failed to return to the facility for scheduled appointments by five days or more	2015 ART guidelines (NDOH) [13]	Telephonic tracing and home visits by CHWs to trace patients who have failed to return to the facility for a scheduled visit by 14 days or more

The AGL guidelines include interventions focused on children and adolescents living with HIV and an integrated care model of patients with chronic conditions.