Primary healthcare providers' perspectives on six-month dispensing of antiretroviral therapy (ART) in South Africa: cross-sectional survey of views and preferences.

Background: Many African countries have increased the dispensing duration of antiretroviral therapy (ART) from 3 months to 6 months for established HIV treatment clients.

Objective: To assess South African healthcare providers' views on the benefits and challenges of the current maximum ART dispensing duration (3-month, 3MMD) and of potential 6-month dispensing (6MMD) to help inform South Africa about whether to move from 3MMD to 6MMD.

Methods: We conducted a cross-sectional survey of healthcare providers at 24 primary healthcare clinics in South Africa from May to September 2024. We used descriptive analysis for quantitative data and analysed open-ended responses using conventional qualitative content analysis methods.

Results: A total of 182 providers were enrolled from four provinces (median age 44, 88% female). Most (>70%) respondents said that 3MMD offered multiple benefits for providers and patients, and most (64%) also said there were no challenges in implementing 3MMD. More than 80% of respondents across all cadres reported that they would be comfortable dispensing 6 months of ART at a time, believing that it would reduce the facility overcrowding, lighten staff workloads, and be advantageous to clients by decreasing their visit burden and travel costs. Two thirds (63%) of participating nurses, who provide the largest share of direct ART care, were also in favour of resuming 12-month scripting for ART; the remaining 37% expressed concerns about decreases in treatment adherence and clinical monitoring of clients.

Conclusion: Most healthcare providers at primary healthcare clinics in South Africa are in favour of allowing 6-month dispensing and 12-month prescriptions as options for established ART clients.