Publication: Evaluation of Interventions to Increase the Proportion of People Living with HIV Who Are Diagnosed, Initiated on, Adhering to and Retained in HIV Treatment and Care in South Africa: Formative Qualitative Research, Phase 1 Report
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2014-11
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2014-11
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This report presents the findings of the first phase of a series of analytical and evaluation studies contributing to the design of an impact and process evaluation of South Africa’s National Adherence Guidelines for Chronic Diseases. The work package is a collaborative effort between the National Department of Health of South Africa, the National Health Laboratory Service (NHLS), the National Institute for Communicable Diseases (NICD), Boston University/Health Economics and Epidemiology Research Office (HE2RO) and the World Bank. The evaluation seeks to answer which mechanisms, strategies and delivery models work best in different settings in South Africa to improve enrolment in ART after HIV diagnosis, adherence to ART and long-term retention in care. The research was conducted in 2014 and consisted of a literature and data review and semi-structured interviews with key informants and health care clients in five selected provinces (Gauteng, KwaZulu-Natal, Limpopo, North West, and Western Cape). Based on the evidence, the report provides recommendations for future treatment adherence models and differentiated care in four priority areas: Improving clients’ understanding of their treatment; Providing focused counselling and grow accountability; Ensuring that there are tools and strategies to assist client self-monitoring; and Reducing barriers to diagnosis, treatment and care. This research contributed to the development of South Africa’s chronic treatment adherence guideline
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“World Bank. 2014. Evaluation of Interventions to Increase the Proportion of People Living with HIV Who Are Diagnosed, Initiated on, Adhering to and Retained in HIV Treatment and Care in South Africa: Formative Qualitative Research, Phase 1 Report. © World Bank. http://hdl.handle.net/10986/25401 License: CC BY 3.0 IGO.”
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The study is evaluating short-term and long-term effects of five interventions being implemented by the National Department of Health (NDoH) in South Africa to improve adherence to HIV care and chronic disease care in general: Fast track initiation counselling, decentralized medicine delivery, adherence clubs, early patient tracing and enhanced adherence counselling. The study uses a randomized evaluation design to compare sites where the intervention was rolled out with control sites providing standard of care. Enrollment began in June 2016 and was uneven in time and by province, as expected in a process using routine data and relying on programmatic implementation. Enrollment of HIV clients into cohorts will enable the NDoH to understand the short-term and long-term impacts of interventions to improve HIV treatment initiation, adherence and retention in care.
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