title: Medication Adherence Clubs: a potential solution to managing large numbers of stable patients with multiple chronic diseases in informal settlements.
abstract: OBJECTIVE
  To assess the care of hypertension, diabetes mellitus and/or HIV patients enrolled into Medication Adherence Clubs (MACs).
  
  
  METHODS
  Retrospective descriptive study was carried out using routinely collected programme data from a primary healthcare clinic at informal settlement in Nairobi, Kenya. All patients enrolled into MACs were selected for the study. MACs are nurse-facilitated mixed groups of 25-35 stable hypertension, diabetes mellitus and/or HIV patients who met quarterly to confirm their clinical stability, have brief health discussions and receive medication. Clinical officer reviewed MACs yearly, when a patient developed complications or no longer met stable criteria.
  
  
  RESULTS
  A total of 1432 patients were enrolled into 47 clubs with 109 sessions conducted between August 2013 and August 2014. There were 1020 (71%) HIV and 412 (29%) non-communicable disease patients. Among those with NCD, 352 (85%) had hypertension and 60 (15%) had DM, while 12 had HIV concurrent with hypertension. A total of 2208 consultations were offloaded from regular clinic. During MAC attendance, blood pressure, weight and laboratory testing were completed correctly in 98-99% of consultations. Only 43 (2%) consultations required referral for clinical officer review before their routine yearly appointment. Loss to follow-up from the MACs was 3.5%.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility and early efficacy of MACs for mixed chronic disease in a resource-limited setting. It supports burden reduction and flexibility of regular clinical review for stable patients. Further assessment regarding long-term outcomes of this model should be completed to increase confidence for deployment in similar contexts.
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Kelly B
authors.initials: KB
authors.lastname: Khabala
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Edwards
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Bienvenu
authors.initials: B
authors.lastname: Baruani
authors.affiliation: National AIDs and STI Control Programme, Nairobi, Kenya.
authors.forename: Martin
authors.initials: M
authors.lastname: Sirengo
authors.affiliation: MOH Langata sub-County, Nairobi, Kenya.
authors.forename: Phylles
authors.initials: P
authors.lastname: Musembi
authors.affiliation: Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
authors.forename: Rose J
authors.initials: RJ
authors.lastname: Kosgei
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Kizito
authors.initials: K
authors.lastname: Walter
authors.affiliation: Noncommunicable Diseases Control Unit, Kenya Ministry of Health, Nairobi, Kenya.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Kibachio
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Monique
authors.initials: M
authors.lastname: Tondoi
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Helga
authors.initials: H
authors.lastname: Ritter
authors.affiliation: Chester University, Chester, UK.
authors.forename: Ewan
authors.initials: E
authors.lastname: Wilkinson
authors.affiliation: Operational Research Unit, Médecins Sans Frontières, Luxembourg, Luxembourg.
authors.forename: Tony
authors.initials: T
authors.lastname: Reid
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007630:Kenya; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies
keywords: Diabetes Mellitus; Hipertensión; Hypertension; SORT IT; SORT-IT; diabète sucré; hypertension; investigación de operaciones; operational research; recherche opérationnelle