Table 1 Initial programme theory of the adherence club intervention

Initial Programme Theory 1

IF adult (18+ years) clinically ‘stable’ patients with evidence of good clinic attendance are group-managed, receive quick symptom checks, quick access to medication, consistent counselling and social support from the peer counsellor,

THEN patients are likely to adhere to medication and remain in care,

BECAUSE they develop a group identity, which improves their perceived social, support, satisfaction and trust; and acquire knowledge, which helps them to understand their perceived threat and perceived benefits and improves their self-efficacy. As a result, they become encouraged, empowered and motivated, thus, more likely to remain in care and adhere to the treatment.

Initial Programme Theory 2

IF operational staff receive goals and targets set to continuously enrol patients in the adherence club and strictly monitor their participation through strict standard operating practices (the promise of exclusion in the event of missed appointment and active patient tracing),

THEN patients are likely to adhere to medication and remain in care,

BECAUSE they fear (perceived fear) losing the benefits (easy access to medication, peer support, reduced waiting times, and two-month ART collection) of the club system and they are coerced through adhesive club rules. As a result, they become nudged to remain in care and adhere to the treatment, which might decongest the health facility.