Skip to main content

Table 1 Innovation timeline for the history of clubs and scaling up

From: 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

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.