Improving the efficiency of monitoring adherence to antiretroviral therapy at primary health care level: a case study of the introduction of electronic technologies in Guguletu, South Africa

This paper presents a case study of the efficiency gains resulting from the introduction of electronic technologies to monitor and support adherence to highly active antiretroviral therapy (HAART) in Guguletu, South Africa. It suggests that the rollout of HAART to such resource-poor communities can be assisted significantly by the introduction of modified cellphones (to provide home based support to people on HAART and improve the management of adherence data) and simple bar-coding and scanning equipment (to manage drug supplies). The cellphones have improved the management of information, and simplified the working lives of therapeutic counsellors, thereby enabling them to spend less time on administration and to devote a constant amount of time per patient even though their case loads have risen threefold. It has helped integrate the local-level primary health service provision of HAART with the kind of centralised data capture and analysis that could potentially support a national HAART rollout.