Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa

Abstract

This report presents the result of the qualitative evaluation to understand the implementation of five adherence interventions from the provider perspective in four South African provinces. The research is part of the evaluation of the new Adherence Guidelines for HIV, TB and other chronic diseases. The study sought to answer four key questions: 1. What are the barriers to and facilitators of implementing the minimum package interventions from the perspective of the providers? 2. What are the strengths and weaknesses of each intervention for HIV positive patients from the perspective of providers? 3. How could implementation of adherence interventions and the minimum package of interventions be improved? 4. What additional strategies do providers feel would be helpful in improving treatment adherence? The report presents the thematic analysis of the qualitative interview transcripts under each of the four questions. Emerging themes are illustrated with quotes from respondents at intervention and control clinics. The results show that providers were generally positive about all the interventions, though they had mixed comments about the Direct Medicine Delivery and Tracing and Retention-in-Care models, largely because they were not always well implemented or providers felt they did not have the resources to implement them at scale. Additionally, providers' views were mixed on their perceived effectiveness of Adherence Clubs.