Redefining Health Routine: Six-month Antiretroviral Prescriptions Drastically Cut Clinic Visits
The six-month multi-month dispensing (6MMD) antiretroviral (ARV) model, aimed at providing stable HIV patients with a six-month supply of medication, is now operational and expanding in certain provinces, such as the Western Cape. This innovative approach, part of a broader differentiated service delivery (DSD) strategy, allows patients to collect their meds only twice a year, reducing clinic visits and decongesting health facilities [1][2][5].
The 6MMD model is supported by national guidelines influenced by World Health Organization recommendations and aims to integrate less intensive treatment models across provinces, with the goal to rapidly scale up 6MMD for millions of people on ART in South Africa and the region [1][2]. However, challenges in implementing 6MMD across provinces have emerged.
One of the main obstacles is the health system's resource constraints. Clinic and community-based service points face challenges such as reduced healthcare worker funding, particularly for lay cadres who support dispensing and patient follow-up [1]. Operational difficulties also arise, with some areas experiencing dismantling of community distribution points and phasing out of group models that previously supported multi-month dispensing, causing setbacks [1].
Another challenge is the variability in provincial rollout. While Western Cape clinics have started implementing 6MMD, widespread consistent adoption across all provinces requires overcoming logistical and supply chain hurdles, as well as ensuring training and support for healthcare workers to manage longer dispensing intervals [2][5]. Furthermore, early progress made during COVID-19, when longer dispensing intervals were favored for infection control and continuity, faces reversal with some reports of shortening refill durations, potentially undermining 6MMD scale-up [1].
Despite these challenges, the 6MMD rollout is expected to help improve patient convenience and accessibility, as well as reduce pressure on clinics. In the Western Cape, for example, the model has already been implemented, easing pressure on staff and improving retention in care [5]. The 6MMD model also includes ARV clubs, which group stable patients and streamline ARV collections, helping to decongest clinics [5].
Policy experts urge faster action on the 6MMD model due to its potential to help the health system cope with a high number of patients and lessen the impact of funding cuts. However, the exact methods of dispensing ARVs, potential costs, funding sources, and the model's impact on patient adherence remain undisclosed [1][2]. A national patient recording system is needed to track where people collect their ARVs from across provinces.
The national rollout of the 6MMD model is scheduled to begin in August, expanding the model to other provinces. For many patients like Neliswa Nkwali, a patient living with HIV for 25 years, the 6MMD model has freed her from clinic queues and allowed her to plan her life [5]. Addressing the challenges outlined above will be critical in achieving broad national coverage and ensuring the success of the 6MMD model.
- The 6MMD model, integrated with less intensive treatment models across provinces, aims to provide mental health support, health-and-wellness resources, fitness-and-exercise programs, and nutrition counseling for patients on antiretroviral therapy (ART).
- To ensure the success of the national rollout of the 6MMD model, it's crucial to prioritize therapies-and-treatments, such as regular mental health assessments, for patients on ART.
- In light of Medicare's interest in scaling up the 6MMD model, it's important to consider the potential impact of the model on patients' fitness-and-exercise habits, mental health, and overall well-being, along with the effects on patient adherence and healthcare costs.
- As the 6MMD model continues to expand, it's essential to gather data on patient outcomes related to their physical health, mental health, and overall wellness, allowing policymakers to make informed decisions regarding the model's future.
