Just being an active member of a club can save a life and make a significant impact on South Africa’s effort to meet the UNAIDS 90-90-90 targets focused on ending the Aids epidemic by 2020. Xabiso Mjiwu, programme coordinator at Right to Care, says: “We are scaling up adherence clubs in South Africa to help patients attending public health facilities who have to take medication every day stay on their treatment and remain healthy. The focus is on people taking antiretroviral therapy (ART) who are clinically stable and includes those on ART who also have non-communicable diseases such as hypertension and diabetes.
“We are setting up over 150 clubs across the provinces of Mpumalanga, Gauteng and the Free State at Department of Health-based facilities. Right to Care is working with numerous community-based organisations which include farm workers organisations and religious groups that have direct contact with communities to implement the adherence club programme. Adherence clubs in KwaZulu-Natal, the Eastern Cape and the Western Cape are also being rolled out.”
“Adherence clubs are open to patients on life-long medication who are doing well but need assistance in adhering to their treatment regimens. Clubs are linked to high volume healthcare facilities and typically comprise about 30 people who meet every second month. They are run by an adherence club facilitator. Club members receive two to three months’ supply of medication, a basic health assessment including weight measurement and TB screening and counselling. Patients then share their stories with one another and discuss the challenges they face taking medication every day of their lives.
“Patients on long-term treatment who feel well can easily become lax with their treatment. But this has serious consequences for them because the risk of drug resistant strains of HIV increases when treatment is interrupted, while patients who stop their diabetic and hypertension regimens can quickly develop serious health issues. This affects already overburdened healthcare facilities which have to absorb these patients again,” says Mjiwu.
Viral load monitoring, which allows a patient’s response to ART to be properly measured and for appropriate treatment to be implemented, also takes place through the adherence clubs. If ART is discontinued, a patient’s viral load will likely return to a detectable level, and the knock-on effect of this has serious health implications.
As well as being facility-based, clubs can also be community-based. They are aligned with the Department of Health’s centralised chronic medicines dispensing and distribution programme and with I-ACT which empowers people in South Africa living with HIV to confidently lead healthy lives.
Mjiwu continues: “This national rollout of adherence clubs will play an important role in freeing up healthcare workers to expand the pressing need to test and treat as many patients as possible to reach the 90-90-90 goals. It also supports the National Department of Health in promoting adherence, as outlined in its adherence guidelines.”
“Patients on ART who are unstable are encouraged to attend support groups that focus mainly on viral load suppression,” says Mjiwu.
Since 2010, new HIV infections in South Africa have decreased by 49% and Aids-related deaths have decreased by 29%.
Popie Mosebetsi is a Right to Care adherence club facilitator at the Krugersdorp central clinic. She started working as a volunteer to help people with HIV/Aids and then completed a facilitation course. Popie runs several adherence clubs in and around the area. Ahead of adherence club meetings, Popie prepares patient files and takes them to the clinic sister for checking. Then, she takes the files to the pharmacy where the medication for each patient – or club member – is packed.
Says Popie: “During a club meeting, no one is forced to participate but the club members do talk and share their experiences. We discuss living healthily and I provide information on diet and lifestyle choices that members can make to keep themselves well. Members are also weighed at every meeting, because weight fluctuations are an important indicator for a variety of different conditions. Sometimes I will refer a patient to a psychologist or social worker, or back to the clinic to see a doctor.”
Ephraim Kometsi and has been a member of the Krugersdorp central clinic adherence club for the past two years. “We share the challenges that having a chronic condition presents, and then discuss how to deal with them. It is helpful to know that other people have the same difficulties,” he says. Margaret de Langa, now in her late 70s, has been living with a chronic condition for around seven years and has been a member of the club for three years. “The club is very informative and helps me make the right decisions on a daily basis about diet and exercise. We give each other support, and encourage one another,” she says.