Related Experiment Video
Updated: Apr 12, 2026
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Medication Adherence Clubs: a potential solution to managing large numbers of stable patients with multiple chronic
Kelly B Khabala1, Jeffrey K Edwards1, Bienvenu Baruani1
1Médecins Sans Frontières, Nairobi, Kenya.
Insights
Medication Adherence Clubs (MACs) effectively manage chronic conditions like hypertension, diabetes, and HIV in resource-limited settings. This nurse-facilitated model shows feasibility and early efficacy, reducing clinical burden.
Area of Science:
- Public Health
- Infectious Diseases
- Chronic Disease Management
Background:
- Managing chronic conditions like hypertension, diabetes mellitus, and HIV requires continuous patient care.
- Resource-limited settings face challenges in providing consistent healthcare for patients with multiple chronic conditions.
- Medication Adherence Clubs (MACs) offer a potential solution for structured, group-based patient management.
Purpose of the Study:
- To evaluate the effectiveness of Medication Adherence Clubs (MACs) in managing patients with hypertension, diabetes mellitus, and/or HIV.
- To assess the quality of care and patient outcomes within the MAC model.
Main Methods:
- A retrospective descriptive study analyzed program data from a primary healthcare clinic in Nairobi, Kenya.
- 1432 patients enrolled in 47 MACs (nurse-facilitated groups of 25-35 stable patients) were included.
- Data covered August 2013 to August 2014, focusing on clinical stability, health discussions, and medication adherence.
Main Results:
- The study included 1020 (71%) HIV patients and 412 (29%) non-communicable disease (NCD) patients (hypertension and/or diabetes).
- High adherence to care protocols was observed, with 98-99% accuracy in blood pressure, weight, and lab testing.
- Low referral rates (2%) and minimal loss to follow-up (3.5%) indicate program effectiveness and patient engagement.
Conclusions:
- Medication Adherence Clubs (MACs) are feasible and demonstrate early efficacy for managing mixed chronic diseases in resource-limited environments.
- The MAC model effectively reduces the burden on regular clinical services by providing flexible reviews for stable patients.
- Further long-term outcome assessments are recommended to build confidence for wider implementation in similar contexts.
Objectives:
To assess the care of hypertension, diabetes mellitus and/or HIV patients enrolled into Medication Adherence Clubs (MACs).
Methods:
Retrospective descriptive study was carried out using routinely collected programme data from a primary healthcare clinic at informal settlement in Nairobi, Kenya. All patients enrolled into MACs were selected for the study. MACs are nurse-facilitated mixed groups of 25-35 stable hypertension, diabetes mellitus and/or HIV patients who met quarterly to confirm their clinical stability, have brief health discussions and receive medication. Clinical officer reviewed MACs yearly, when a patient developed complications or no longer met stable criteria.
Results:
A total of 1432 patients were enrolled into 47 clubs with 109 sessions conducted between August 2013 and August 2014. There were 1020 (71%) HIV and 412 (29%) non-communicable disease patients. Among those with NCD, 352 (85%) had hypertension and 60 (15%) had DM, while 12 had HIV concurrent with hypertension. A total of 2208 consultations were offloaded from regular clinic. During MAC attendance, blood pressure, weight and laboratory testing were completed correctly in 98-99% of consultations. Only 43 (2%) consultations required referral for clinical officer review before their routine yearly appointment. Loss to follow-up from the MACs was 3.5%.
Conclusions:
This study demonstrates the feasibility and early efficacy of MACs for mixed chronic disease in a resource-limited setting. It supports burden reduction and flexibility of regular clinical review for stable patients. Further assessment regarding long-term outcomes of this model should be completed to increase confidence for deployment in similar contexts.
Related Concept Videos
01:28Drug Therapy
Antianxiety Medications
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
01:28Chronic Kidney Disease III: Interprofessional Care
01:29Chronic Obstructive Pulmonary Disease-V: Management
Smoking Cessation
01:21Rheumatic Heart Disease III: Medical Management
01:15Drug Dosing: Geriatric Patients