title: Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa.
abstract: BACKGROUND
  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. We adopted the realist evaluation approach to evaluate what aspects of antiretroviral club intervention works, for what sections of the patient population, and under which community and health systems contexts, to inform guidelines for scaling up of the intervention. In this article, we report on a step towards the development of a programme theory-the assumptions of programme designers and health service managers with regard to how and why the adherence club intervention is expected to achieve its goals and perceptions on how it has done so (or not).
  
  
  METHODS
  We adopted an exploratory qualitative research design. We conducted a document review of 12 documents on the design and implementation of the adherence club intervention, and key informant interviews with 12 purposively selected programme designers and managers. Thematic content analysis was used to identify themes attributed to the programme actors, context, mechanisms, and outcomes. Using the context-mechanism-outcome configurational tool, we provided an explanatory focus of how the adherence club intervention is roll-out and works guided by the realist perspective.
  
  
  RESULTS
  We classified the assumptions of the adherence club designers and managers into the rollout, implementation, and utilisation of the adherence club programme, constructed around the providers, management/operational staff, and patients, respectively. Two rival theories were identified at the patient-perspective level. We used these perspectives to develop an initial programme theory of the adherence club intervention, which will be tested in a later phase.
  
  
  CONCLUSIONS
  The perspectives of the programme designers and managers provided an important step towards developing an initial programme theory, which will guide our realist evaluation of the adherence club programme in South Africa.
authors: School of Public Health, University of the Western Cape, Bellville, Western Cape Province, South Africa.|Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors: Ferdinand C
authors: FC
authors: Mukumbang
authors: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Institute of Development and Management, University of Antwerp, Antwerp, Belgium.
authors: Sara
authors: S
authors: van Belle
authors: School of Public Health, University of the Western Cape, Bellville, Western Cape Province, South Africa.|Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors: Bruno
authors: B
authors: Marchal
authors: School of Public Health, University of the Western Cape, Bellville, Western Cape Province, South Africa.
authors: Brian
authors: B
authors: van Wyk
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods* / Q000592:standards; D006801:Humans; D055118:Medication Adherence; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D015397:Program Evaluation; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents