title: "They just come, pick and go." The Acceptability of Integrated Medication Adherence Clubs for HIV and Non Communicable Disease (NCD) Patients in Kibera, Kenya.
abstract: BACKGROUND
  The number of people on antiretroviral therapy (ART) for the long-term management of HIV in low- and middle-income countries (LMICs) is continuing to increase, along with the prevalence of Non-Communicable Diseases (NCDs). The need to provide large volumes of HIV patients with ART has led to significant adaptations in how medication is delivered, but access to NCD care remains limited in many contexts. Medication Adherence Clubs (MACs) were established in Kibera, Kenya to address the large numbers of patients requiring chronic HIV and/or NCD care. Stable NCD and HIV patients can now collect their chronic medication every three months through a club, rather than through individual clinic appointments.
  
  
  METHODS
  We conducted a qualitative research study to assess patient and health-care worker perceptions and experiences of MACs in the urban informal settlement of Kibera, Kenya. A total of 106 patients (with HIV and/or other NCDs) and health-care workers were purposively sampled and included in the study. Ten focus groups and 19 in-depth interviews were conducted and 15 sessions of participant observation were carried out at the clinic where the MACs took place. Thematic data analysis was conducted using NVivo software, and coding focussed on people's experiences of MACs, the challenges they faced and their perceptions about models of care for chronic conditions.
  
  
  RESULTS
  MACs were considered acceptable to patients and health-care workers because they saved time, prevented unnecessary queues in the clinic and provided people with health education and group support whilst they collected their medication. Some patients and health-care workers felt that MACs reduced stigma for HIV positive patients by treating HIV as any other chronic condition. Staff and patients reported challenges recruiting patients into MACs, including patients not fully understanding the eligibility criteria for the clubs. There were also some practical challenges during the implementation of the clubs, but MACs have shown that it is possible to learn from ART provision and enable stable HIV and NCD patients to collect chronic medication together in a group.
  
  
  CONCLUSIONS
  Extending models of care previously only offered to HIV-positive cohorts to NCD patients can help to de-stigmatise HIV, allow for the efficient clinical management of co-morbidities and enable patients to benefit from peer support. Through MACs, we have demonstrated that an integrated approach to providing medication for chronic diseases including HIV can be implemented in resource-poor settings and could thus be rolled out in other similar contexts.
authors.affiliation: Médecins Sans Frontières Southern Africa Medical Unit, Cape Town, South Africa.|Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Emilie
authors.initials: E
authors.lastname: Venables
authors.affiliation: Medical Department, Operational Centre Brussels, Médecins Sans Frontières Belgium, Brussels, Belgium.
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Edwards
authors.affiliation: Médecins Sans Frontières Southern Africa Medical Unit, Cape Town, South Africa.
authors.forename: Saar
authors.initials: S
authors.lastname: Baert
authors.affiliation: Medical Department, Operational Centre Brussels, Médecins Sans Frontières Belgium, Brussels, Belgium.
authors.forename: William
authors.initials: W
authors.lastname: Etienne
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Kelly
authors.initials: K
authors.lastname: Khabala
authors.affiliation: Médecins Sans Frontières Southern Africa Medical Unit, Cape Town, South Africa.
authors.forename: Helen
authors.initials: H
authors.lastname: Bygrave
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000379:methods / Q000523:psychology*; D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007630:Kenya; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D036301:Qualitative Research; D014505:Urban Population