# South Africa's new Central Chronic Medicine Dispensing and Distribution program: assessing the clinic, patient, and community impact

> **NIH NIH R01** · MASSACHUSETTS GENERAL HOSPITAL · 2020 · $682,927

## Abstract

Project Summary
Achieving the UNAIDS 90-90-90 target by 2020 in sub-Saharan Africa will require innovative solutions to meet
the increasing demands placed on public health care facilities. With ART coverage in sub-Saharan Africa
hovering around 50%, health systems face the dual challenge of increasing HIV testing and ART enrollment for
those not yet in care and continuing to provide treatment to the millions of people already on ART. Community-
based ART delivery is a potential strategy for maintaining long-term virologic suppression and retention in HIV
care. South Africa’s new Central Chronic Medicine Dispensing and Distribution (CCMDD) program allows
clinically stable patients to choose from a list of community pick-up points (e.g., private pharmacies, schools,
churches) to access ART and therefore has the potential to offer more convenient services to patients and to
decompress health facilities. The current proposal leverages this national policy change to assess the impact
of this large scale service delivery intervention at the patient-, clinic-, and community-level over time in the
high-density settlement of Umlazi in Durban, South Africa. Using a mixed-methods approach that incorporates
the Practical, Robust Implementation and Sustainability Model (PRISM), we will comprehensively evaluate the
impact of CCMDD at all 10 public sector clinics in Umlazi through the following specific aims:
1) To prospectively assess patient uptake of CCMDD and patient factors associated with favorable early
clinical outcomes for CCMDD enrollees and to compare outcomes with non-enrollees; 2) To evaluate
facilitators of and barriers to adoption of CCMDD by patients, clinic staff, and administrators using qualitative
methods, and 3) To evaluate virologic suppression over time across all 10 public sector clinics in Umlazi using
programmatic electronic health record data.
This proposal is motivated by PA-17-182 to better understand system-level interventions using implementation
science, which may increase the number of people consistently engaged in HIV care. We have played a major
role for over a decade implementing and evaluating interventions along the HIV care continuum in South Africa
and are well-positioned to evaluate the impact of this important policy change. Our results will inform clinical
leaders and policymakers in high HIV prevalence settings developing community ART delivery systems that
will enable life-long therapy for millions of people living with HIV. This research has the potential to change
clinical practice throughout sub-Saharan Africa, where innovative and efficient approaches to long-term
community-based HIV treatment delivery are urgently needed.

## Key facts

- **NIH application ID:** 9934010
- **Project number:** 5R01MH114997-03
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Ingrid Valerie Bassett
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $682,927
- **Award type:** 5
- **Project period:** 2018-07-26 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9934010

## Citation

> US National Institutes of Health, RePORTER application 9934010, South Africa's new Central Chronic Medicine Dispensing and Distribution program: assessing the clinic, patient, and community impact (5R01MH114997-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9934010. Licensed CC0.

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