Evaluation of the National Department of Health’s National Adherence Guidelines for Chronic Diseases in South Africa (ENHANCE)

The South African Department of Health (NDoH) has developed the “National Adherence Guidelines for Chronic Diseases (HIV, TB and NCDs)” and is in the process of implementing these nationally. The guidelines outline the provision of a minimum package of interventions which are designed to increase linkage to and retention in care and adherence to treatment. In order inform the national roll-out, HE2RO and Boston University, in collaboration with the National Department of Health and The World Bank, will be evaluating implementation of the minimum package interventions using a cluster randomised design. Twelve matched pairs of primary health clinics and community health centres have been selected in four provinces (Gauteng, KwaZulu Natal, Limpopo and North West) and facilities randomly allocated to control and intervention within each pair.

The evaluation consists of two components. The first protocol is an effectiveness evaluation that uses routinely collected data to a) assess the impact of 5 of the 8 minimum package interventions; b) estimate the costs of the interventions; and c) describe the cascade of care for TB, hypertension and diabetes at the clinics. The second protocol is an implementation process evaluation which will describe and assess which interventions are actively taken up by the study clinics, the processes by which the interventions are being implemented, patients’ perceptions of the quality of care associated with the interventions, and providers’ perspectives on the experience of implementing the interventions. To date there have been no studies that have explored the effectiveness of the minimum package interventions when delivered together and at scale in public sector facilities. This evaluation is of critical importance in terms of guiding the National Department of Health’s roll out of the Adherence Strategy and proposed interventions.

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