Table 1 Innovation timeline for the history of clubs and scaling up
Period | Development of adherence club model | Context |
|---|---|---|
Pre-adherence clubs | ||
2000–2004 | Prior to government roll out in 2004, MSF provided some ART in Khayelitsha, Cape Town. | HIV + ve patients started on ART in Cape Town. |
2005- | Initiatives were introduced exploring models of service delivery to decongest facilities and streamline treatment in Cape Town area. | As increasing number of HIV patients received care, key stakeholders considered the decentralization of HIV services to decongest health facilities. |
Post-adherence clubs | ||
2007 | Stable patients moved to adherence clubs in 1 facility in Khayelitsha. | MSF has pioneered various models for decentralised and community-based distribution of ART in other African settings, such as community adherence groups |
2010 | MSF began discussions with the WCDoH and CCTDoH to adopt the model in Cape Town. | Funding for scaling up health innovations came from the Institute for Healthcare Improvement (IHI) which allowed the scale up of the club model. |
2011 | The roll-out of the model was instituted in facilities managed by both WCDoH and CCTDoH. The club model became instituted as policy. | The CCTDoH provided external support to the roll-out through central health staff. Likewise, the WCDoH gave this role to HAST medical officers in the substructures. |
2012 | Community clubs, youth clubs started to emerge. | The club initiative won a platinum award from the Impumelelo Social Innovations Centre. Over 15% of people on ART in Cape Town were part of clubs. |
2012- | The club model is expanded to include co-morbidity clubs, family clubs and male clubs. | Emerging evidence suggest that stable patients on long-term ART can safely be offered differentiated care options. |