Philosophiae Doctor - PhD (School of Public Health)In South Africa, 7.1 million people living with HIV/AIDS (PLWHA) of whom
about 56% were accessing antiretroviral therapy (ART) in 2016, accounted for approximately 20%
of people on ART globally. The successful initiation of PLWHA on ART has engendered
challenges of poor retention in care and suboptimal adherence to medication. While standard
treatment and care schemes show the potential to retain patients in ART care, their success is
challenged by congested health-care facilities, long waiting times and shortages of health-care
providers. The antiretroviral adherence club intervention was rolled out in primary health-care
facilities in the Western Cape Province of South Africa to relieve clinic congestion and improve
retention in care, and treatment adherence in the face of growing patient loads. Evidence from the
literature suggests that these models of ART service delivery are more effective than corresponding
facility-based care. Nevertheless, there is little understanding of how these care models work to
achieve their intended outcomes. To this end, a theory-driven approach to evaluate the adherence
club intervention was proposed
