A Qualitative Assessment of South Africa's Central Chronic Medication Dispensing and Distribution Program for Differentiated Antiretroviral Therapy Delivery in Umlazi Township, South Africa: Client Perspectives after 12 Months of Participation

Alexandra Mendoza-Graf; Laura M Bogart; Zinhle Shazi; Anele Khumalo; Nabeel Qureshi; Kashfia Rahman; Sabina Govere; Dani Zionts; Mpilonhle Nzuza; Ingrid V Bassett

doi:10.1007/s10461-024-04549-y

A Qualitative Assessment of South Africa's Central Chronic Medication Dispensing and Distribution Program for Differentiated Antiretroviral Therapy Delivery in Umlazi Township, South Africa: Client Perspectives after 12 Months of Participation

AIDS Behav. 2024 Nov 12. doi: 10.1007/s10461-024-04549-y. Online ahead of print.

Authors

Alexandra Mendoza-Graf^#¹, Laura M Bogart^#^{1

2}, Zinhle Shazi³, Anele Khumalo³, Nabeel Qureshi¹, Kashfia Rahman⁴, Sabina Govere³, Dani Zionts⁴, Mpilonhle Nzuza³, Ingrid V Bassett^{5

6

7

8

9}

Affiliations

¹ RAND Corporation, Santa Monica, CA, USA.
² Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
³ AIDS Healthcare Foundation, Durban, South Africa.
⁴ Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
⁵ Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA. ibassett@mgh.harvard.edu.
⁶ Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA. ibassett@mgh.harvard.edu.
⁷ Center for AIDS Research (CFAR), Harvard University, Boston, MA, USA. ibassett@mgh.harvard.edu.
⁸ Harvard Medical School, Boston, MA, USA. ibassett@mgh.harvard.edu.
⁹ Africa Health Research Institute, Durban, South Africa. ibassett@mgh.harvard.edu.

^# Contributed equally.

PMID: 39531117
DOI: 10.1007/s10461-024-04549-y

Abstract

South Africa's Central Chronic Medicine Dispensing and Distribution (CCMDD) program provides community-based medication delivery for clinically stable people with HIV (PWH) on antiretroviral therapy (ART). To evaluate CCMDD implementation, we conducted semi-structured interviews with 60 PWH enrolled in CCMDD for at least 12 months. In a directed content analysis based on the Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework, key themes were compared with qualitative data collected from PWH enrolling in CCMDD at an earlier time-point. Results indicated consistently positive views of CCMDD, primarily attributed to convenient and smooth medication pick-up. At the later (vs. earlier) time-point, participants discussed less clinic crowding, mentioned few medication errors, and noted improved communication around refills. Community HIV stigma was a persistent challenge, as was nurses' judgmental communication style. To ensure CCMDD's success, continued focus is needed on decreasing HIV stigma beyond the clinic context and improving provider-patient relationships.

Keywords: AIDS; Antiretroviral therapy; Central Chronic Medicine Dispensing and Distribution; HIV; Implementation science.

Abstract

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