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. 2025 Dec;18(1):2484111.
doi: 10.1080/16549716.2025.2484111. Epub 2025 Apr 9.

Primary healthcare providers' perspectives on six-month dispensing of antiretroviral therapy (ART) in South Africa: cross-sectional survey of views and preferences

Vinolia Ntjikelane  1 , Amy Huber  1 , Allison Morgan  2 , Sophie Pascoe  1 , Musa Manganye  3 , Lufuno Malala  3 , Sydney Rosen  1   2
Affiliations

Primary healthcare providers' perspectives on six-month dispensing of antiretroviral therapy (ART) in South Africa: cross-sectional survey of views and preferences

Vinolia Ntjikelane et al. Glob Health Action. 2025 Dec.

Abstract

Background: Many African countries have increased the dispensing duration of antiretroviral therapy (ART) from 3 months to 6 months for established HIV treatment clients.

Objective: To assess South African healthcare providers' views on the benefits and challenges of the current maximum ART dispensing duration (3-month, 3MMD) and of potential 6-month dispensing (6MMD) to help inform South Africa about whether to move from 3MMD to 6MMD.

Methods: We conducted a cross-sectional survey of healthcare providers at 24 primary healthcare clinics in South Africa from May to September 2024. We used descriptive analysis for quantitative data and analysed open-ended responses using conventional qualitative content analysis methods.

Results: A total of 182 providers were enrolled from four provinces (median age 44, 88% female). Most (>70%) respondents said that 3MMD offered multiple benefits for providers and patients, and most (64%) also said there were no challenges in implementing 3MMD. More than 80% of respondents across all cadres reported that they would be comfortable dispensing 6 months of ART at a time, believing that it would reduce the facility overcrowding, lighten staff workloads, and be advantageous to clients by decreasing their visit burden and travel costs. Two thirds (63%) of participating nurses, who provide the largest share of direct ART care, were also in favour of resuming 12-month scripting for ART; the remaining 37% expressed concerns about decreases in treatment adherence and clinical monitoring of clients.

Conclusion: Most healthcare providers at primary healthcare clinics in South Africa are in favour of allowing 6-month dispensing and 12-month prescriptions as options for established ART clients.

Keywords: 12-month prescriptions; 6MMD; ART; South Africa; healthcare providers.

Plain language summary

Main findings: Most primary healthcare providers in South Africa are in favor of shifting from 3-month dispensing of antiretroviral medications for HIV treatment, which is the status quo, to 6-month dispensing, which has been shown to be successful in other countries, and believe that 6-month dispensing will have benefits for both patients and providers.Added knowledge: This study fills a gap about between the perspectives of healthcare providers on a policy change that is being considered by the South African National Department of Health and provides evidence on what providers view as the benefits and drawbacks of a move to 6-month dispensing.Global health impact for policy and action: These results support adopting 6-month dispensing of antiretroviral medications in South Africa, where the success of what is the world’s largest HIV treatment program is critical both for the global HIV response and as a model for other countries.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Repeat prescription collection annual schedule*.
Figure 2.
Figure 2.
Provider reported benefits and challenges of 3-month ART dispensing (N=149).
Figure 3.
Figure 3.
Providers’ views on longer ART dispensing durations, stratified by provider role.
See this image and copyright information in PMC

References

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