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Table 2 Possibilities for further innovation

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

Existing innovation that have developed in the club model Purpose Transferability to other chronic diseases Anticipated new challenges Potential future innovation
Services Delivery
Specialized clubs Address special needs of patients (eg, families and adolescents) Yes, transferable in some cases (eg. diabetes) Other needs that could be addressed with separate clubs Clubs for migrants, older people, sex workers etc.
Quick-Pick-UP (QPUP) Lengthy times at facilities and desire for even greater convenience and collection flexibility Yes, transferable Other pharmacy pick up models Private pharmacies, dispensing machines, home delivery options, use of unique patient identifiers
Community clubs Improve community involvement, reduce stigma Yes, transferable   Decentralised community medication distribution
Recruitment champion Number of club members plateauing and reluctance to recruit Yes, transferable Club numbers vary across facilities Roving club recruiter/mentors
Health workforce
Task shifting of clinical care to HIV counsellors / CHWs extended to include moves for low-level pharmacy assistants Initial task-shifting to CHWs because clinicians overburdened with stable patients; now need to ensure legal dispensing of medication and to relieve pharmacy staff. Yes, transferable Constant updates on clinical care issues needed Creative training / mentoring of HIV counsellors / CHWs and of staff dispensing medication
Medical Products
The ‘jump’ (the seasonal shift to a 4 month drug dispensing cycle over Christmas) Seasonal migration of patients Yes, transferable Client push for 4 monthly visits/refills to become the norm Annual script
Electronic scripting for processing the volume of scripts for CDU Time taken with manual scripting Yes, transferable Harmonising of the electronic scripting with the official Western Cape systems; Capacity and resources for a paperless system Electronic transfers of scripts from pharmacies to CDU and integration of CDU system with pharmacy stocktaking systems
  1. This table describes (1) existing innovations that have developed around the core club concept, (2) the purpose for which they were developed, (3) transferability to care for other chronic dieases, (4) anticipated new challenges that could emerge, and (5) likely future possibilities for further innovations