Table 3 Summary of how CBD elements facilitate or constrain CBD implementation

o Centralised dispensing simplifies distribution process.

o Quality assurance processes must be fulfilled by HCPs prior to “last mile” distribution;

o Stock-outs of medicines cripples CBD models;

o Non-collected medicines cannot be re-dispensed.

Human resources

Community Health Workers

o Positive, close relationships with patients which can facilitate active follow-up when necessary.

o Not able to conduct quality assurance processes.

HCPs

o Missing medicines from patient-ready parcels can be dispensed manually by the HCP at the CBD site.

o General shortage of HCPs undermine sustainability of deploying them to CBD sites.

Informal providers

o Demand-driven therefore likely to suit beneficiary needs.

o No governmental oversight which could lead to financial exploitation of patients;

o no accountability to professional statutory body which could compromise quality of pharmaceutical services.

o Government vehicles available for transportation of medicines for some models.

o Poor transport systems for CHWs causing delays and posing security and environmental risks to medicines;

o Availability of venues not always guaranteed.

o Positive patient-patient; patient-provider relationships;

o Some patients knowledgeable about their treatment regimen and proactive in addressing medicine-related concerns.

o Stigma associated with HIV still a reality.