Factors contributing to non-adherence to the Central Chronic Medicine Dispensing and distribution programme amongst patients on anti-retroval theraphy referred from a community health centre in the Capricorn District, Limpopo Province

Abstract

Introduction: Amid the national and global increase in HIV prevalence and a growing dependence on Differentiated Service Delivery (DSD) models, the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme was introduced to decongest healthcare facilities and improve access to lifesaving medication in managing chronic disease. However, challenges such as missed medication collection and appointment renewals threaten its efficacy. Therefore, this study aimed to examine the factors that influence non-adherence to the CCMDD programme among patients receiving Antiretroviral Therapy (ART) at a Community Health Centre (CHC) in Capricorn district, Limpopo Province. Methodology: The study was conducted in two phases using a quantitative, descriptive research design that incorporated both retrospective data in phase 1 and prospective data in phase 2. The dataset for missed Patient Medicine Parcels (PMP) from the Synchronised National Communication in Health (SyNCH) system from 2020 to 2023 was used in phase 1 to identify the prevalence of non-adherence to PMP collections for the patients registered to the CCMDD programme at the study site. Whereas phase 2 used a convenience sampling method to recruit participants who missed their PMP collections at the Pick-up Point (PuP) and missed a clinic appointment at the study site. A structured participant questionnaire was used to obtain socio-demographic information, and the patient reported reasons for non-adherence to the collection of PMPs and missed appointments for prescription renewal. Statistical Package for the Social Sciences (SPSS) version 30 was used for data analysis to determine the prevalence of non-adherence based on recorded missed collections at PuPs and the association between socio-demographic, CCMDD characteristics, and missed PMP collections during phase 1 as per the SyNCH data. In phase 2, the socio-demographic, CCMDD characteristics, and the reasons for non-adherence were presented in frequencies and percentages. Association between socio-demographic, CCMDD characteristics, and missed PMP collection and missed appointment prescription renewal (categorical variables) was identified using the Pearson Chi-square test. Multivariate linear regression analysis was conducted to determine the socio-demographic and CCMDD predictors of non-adherence to the collection of PMP and missed clinic appointments for prescription renewal. A correlation analysis was performed to identify the association between missed collections of PMP and missed clinic appointments among participants; and number of missed clinic appointments with the number of days participants took to return to the clinic. A p-value of ≤0.05 was considered significant in this study. The ethical clearance (TREC/1410/2024: PG) to conduct this study was obtained from the Turfloop Research and Ethics Committee (TREC) of the University of Limpopo. Results: In Phase 1 of the study, secondary data included 3,618 patients. Approximately two-thirds of the sample were females (n=2354; 65.1%), and more than half (n=1883; 52%) of the patients were aged between 36-50 years. The prevalence of non-adherence to CCMDD was 3.1% in 2020, 19.2% in 2021, peaked in 2022 (22.4%), and dropped to 10.7% in 2023. A strong association (p<0.05) between socio-demographic and CCMDD characteristics such as gender, age, PuP, months supplied, and ART regimen prescribed, with missed collection of PMP was observed. In phase 2, a sample of 285 patients were recruited. More than half of the participants were female (57.9%; n=165), and more than a quarter (29.5%; n=84) were aged between 45 and 54. Socio-demographic and CCMDD characteristics such as age, PuP, SMS receipt, missed clinic appointments, and duration on CCMDD were significantly (p ≤ 0.05) associated with missed collection of PMP since 2020. A strong association (p<0.05) was identified between socio-demographic and CCMDD characteristics, such as age, SMS received, return days after missed appointment, and duration on CCMDD with missed clinic appointments since 2020. SMS received (β= 0.154; p= 0.009), returned days after missed (β= -0.189; p= 0.001), and duration on CCMDD (β= -0.194; p<0.001) were identified as predictors of missed collection of PMP since 2020. Age (β= 0.191; p= 0.001), SMS received (β= -0.158; p= 0.007), returned days after missed (β= 0.370; p<0.001), and duration on CCMDD (β= 0.232; p<0.001) were identified as predictors of the missed clinic appointment. A strong correlation existed between missed PMP collections and missed clinic appointments (p<0.001), indicating that patients who frequently fail to collect their PMPs are also more likely to miss their scheduled clinical appointments. The most frequently cited reasons for non-adherence to missed collection of PMP and missed clinic appointment for prescription renewal were having sufficient pills at home (87%), work-related issues (36.5%), not receiving SMS notifications (26%), family responsibilities (22.8%), and forgetting appointments (21.4%). Conclusion: The study identified that non-adherence to the CCMDD programme is multifactorial, with socio-demographic characteristics, system-related factors (e.g., SMS notifications, PuPs), personal circumstances (e.g., work, family), and behavioural misconceptions (forgetting and misreading appointments) influencing adherence behaviours.