Table 4.
Recommendations for changes to CCMDD implementation
| Patient-level recommendations |
| Provide patient education |
| “It would be better if they include it in their health education while we are still there in the front, that there is a program like this so that we can try to inform people…I'll make an example. My brother just started the treatment, but he does not know anything about the CCMDD program. I even asked him to take the transfer and come to my clinic so that I help him because he was not doing well. So, they don't advertise it enough.” (Patient, Clinic Pick-up Point) |
| “If they could teach them properly, from the basics, then they won't be confused and they won't have lots of questions and they won't get angry and upset. If they are taught, you only come on that day for your medication and they told those things, we won't have problems at the pharmacy. And if you tell them it's only available for so many days, so they can [tell] themselves, ‘Okay, I don't have to take off on that day. I have 7 days I can collect in the weekend. I don't have to miss a day of work.’ ” (Pharmacy Assistant, External Pick-up Point) |
| Foster clear communication with patients |
| “…They should give the person the pills [anyway, even if the text reminder is not sent] because sometimes the message… comes late… I once had a problem because on my phone, I am used to getting a message. On this unfortunate day the message didn’t come through… and the date that is written on my card passed. I then came to the clinic, when I got to the clinic the nurses said ‘no, did the message come in?’ I said, ‘the message didn’t come but it is my date.’ They said, ‘no sisi, you have to go back and wait for the message.’ I was very disappointed because I did a fruitless trip, yet it was my date. They said you mustn’t come if you haven’t received a message, you must only come if you have received a message because it means that your pills are not yet ready. They haven’t arrived here for you to get them as you haven’t received a message. I said, ‘but it’s my date so what is wrong?’ They said, ‘if the message hasn’t come it means your pills are not ready and they haven’t arrived here from where they come from; so, it means they are not ready so please go home.’ I only came back after I had received a message. I had even defaulted as I didn’t have pills and I didn’t know where to get them.” (Patient, Clinic) |
| “For the program to run more smoothly there must be better communication channels so patients get clear messages when [texts] are sent, for instance if the pick-up date is the next day then it must clearly state this in the message because people need information that is easy to understand.” (Lay Counsellor, Clinic Pick-up Point) |
| Organizational-level recommendations |
| Improve program infrastructure |
| “An addition of pick-up points would have a good effect. …Inside the clinic, sisters get a lot of people and in this time that we are into right now, the time of Covid, I wish they could see fewer people. The clinic should be empty. Another thing, it makes life easy for us, the patients… we can go and pick up from the office. It’s near, I don’t take a taxi… I wish other places can be added if possible because in other places we struggle for money to go to [pick-up points].” (Patient, Clinic Pick-up Point) |
| “…If there could be more [smart lockers], so that a person comes to collect their treatment and go home. Because sometimes it irritates people to stay in the facility for a long time.” (Data Capturer, Clinic Pick-up Point) |
| Hire dedicated CCMDD staff |
| “If there can be someone who deals specifically with people who come to collect, it would be fine because you would just come and take your parcel and leave. You’ll be able to get to work on time.” (Patient, Clinic Pick-up Point) |
| “If they wanted this program to work and maximize the money they have put into it, they should have brought it’s own staff…You know that you have a nurse for the CCMDD, you have a clerk and a doctor; ok not necessarily a doctor but you have some [team].” (Pharmacist, External Pick-up Point) |
| Increase training opportunities |
| “Maybe if they can get someone who understands CCMDD and HIV because I don’t know whether [staff] here at the clinic don’t understand or what. I just don’t understand them.” (Patient, Clinic Pick-up point) |
| “[There should be] a training to encourage to put people on CCMDD so that there will not be lines, complaints and all that” (Provider, Clinic Pick-up point) |
| CCMDD program-level recommendations |
| Change CCMDD renewal and refill policies |
| “They can improve by increasing the pills to be taken every 4–6 months, not 2 months, as long as we are keeping our viral load and CD4 count low.” (Patient, Clinic) |
| “I think it would help if patients can renew their scripts at the pick-up points because that would save patients times and lower the number of patients who end up defaulting…” (Lay Counsellor, Clinic Pick-up point) |
| Add family planning |
| “[CCMDD should have family planning at pick-up points] because family planning also has its own date, so if you are working, you have to be absent from work twice a month.” (Patient, Clinic Pick-up point) |
| Monitor and provide feedback |
| “What troubles me is the fact that we do not receive feedback on the performance of CCMDD in the facility. We need to know whether or not we meet targets on CCMDD enrolments. If we are having challenges on the program, they want us to send email; with whose data? Right now we are not even sure on who to direct or grievances if we have any.” (Nurse/CCMDD Eligibility Screener/Champion, Clinic Pick-up point) |