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Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation

Overview of attention for article published in Globalization and Health, April 2018
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1 tweeter

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135 Mendeley
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Title
Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation
Published in
Globalization and Health, April 2018
DOI 10.1186/s12992-018-0351-z
Pubmed ID
Authors

Hayley MacGregor, Andrew McKenzie, Tanya Jacobs, Angelica Ullauri

Abstract

In 2011, a decision was made to scale up a pilot innovation involving 'adherence clubs' as a form of differentiated care for HIV positive people in the public sector antiretroviral therapy programme in the Western Cape Province of South Africa. In 2016 we were involved in the qualitative aspect of an evaluation of the adherence club model, the overall objective of which was to assess the health outcomes for patients accessing clubs through epidemiological analysis, and to conduct a health systems analysis to evaluate how the model of care performed at scale. In this paper we adopt a complex adaptive systems lens to analyse planned organisational change through intervention in a state health system. We explore the challenges associated with taking to scale a pilot that began as a relatively simple innovation by a non-governmental organisation. Our analysis reveals how a programme initially representing a simple, unitary system in terms of management and clinical governance had evolved into a complex, differentiated care system. An innovation that was assessed as an excellent idea and received political backing, worked well whilst supported on a small scale. However, as scaling up progressed, challenges have emerged at the same time as support has waned. We identified a 'tipping point' at which the system was more likely to fail, as vulnerabilities magnified and the capacity for adaptation was exceeded. Yet the study also revealed the impressive capacity that a health system can have for catalysing novel approaches. We argue that innovation in largescale, complex programmes in health systems is a continuous process that requires ongoing support and attention to new innovation as challenges emerge. Rapid scaling up is also likely to require recourse to further resources, and a culture of iterative learning to address emerging challenges and mitigate complex system errors. These are necessary steps to the future success of adherence clubs as a cornerstone of differentiated care. Further research is needed to assess the equity and quality outcomes of a differentiated care model and to ensure the inclusive distribution of the benefits to all categories of people living with HIV.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 135 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 135 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 26 19%
Researcher 25 19%
Student > Ph. D. Student 13 10%
Lecturer > Senior Lecturer 10 7%
Student > Doctoral Student 8 6%
Other 34 25%
Unknown 19 14%
Readers by discipline Count As %
Nursing and Health Professions 23 17%
Medicine and Dentistry 16 12%
Business, Management and Accounting 10 7%
Agricultural and Biological Sciences 10 7%
Social Sciences 10 7%
Other 34 25%
Unknown 32 24%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 April 2018.
All research outputs
#10,264,615
of 12,858,386 outputs
Outputs from Globalization and Health
#643
of 668 outputs
Outputs of similar age
#203,584
of 269,921 outputs
Outputs of similar age from Globalization and Health
#1
of 1 outputs
Altmetric has tracked 12,858,386 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
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