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Publications

Journal Article Epublish

PubMed: 42699462 DOI: 10.4102/jphia.v17i1.1745

Stakeholder perspectives on the feasibility and uptake of the cardiovascular polypill in South Africa.

J Public Health Afr 17(1):1745

Authors: Trudy D Leong, Bey-Marrie Schmidt, Liesel Zühlke, Robyn Curran, Jane Simmonds, Ntobeko A B Ntusi, Tamara Kredo, Lara Fairall

Affiliations

  • Health Systems Research Unit, South African Medical Research Council, Parow Valley, South Africa.
  • Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
  • Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
  • Office of the President, South African Medical Research Council, Parow Valley, South Africa.
  • Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa.
  • Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa.

Abstract

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death globally, with a disproportionate burden in low- and middle-income countries (LMIC). Cardiovascular (CV) polypills, combining a statin with two or three antihypertensive agents, improve adherence, risk-factor control and outcomes, but uptake remains limited. In South Africa, they are unavailable in the public sector and rarely used privately.

AIM

To explore stakeholder perspectives on the feasibility, acceptability and potential uptake of CV polypills in South African primary care.

SETTING

Primary healthcare and health-system contexts in South Africa.

METHODS

We conducted semi-structured interviews with 15 purposively sampled stakeholders from clinical, policy, regulatory, industry and advocacy sectors. Data were analysed thematically using ATLAS.ti, with reflexivity, peer debriefing and participant validation to enhance rigour.

RESULTS

Stakeholders viewed polypills as a promising strategy to simplify treatment, improve adherence and strengthen cardiovascular prevention. Barriers included formulation constraints, weak commercial incentives, regulatory complexity, inequitable access and limited local evidence. Pharmacological prevention was seen as complementary to risk screening and lifestyle interventions. Participants called for context-specific research, coordinated policy action, streamlined regulation, equitable procurement, advocacy-led demand generation and strong government leadership.

CONCLUSION

Cardiovascular polypills could improve prevention and outcomes in South Africa and similar LMIC settings, but scale-up will require local evidence and coordinated multisectoral action to overcome regulatory, procurement, access and health-system barriers.

CONTRIBUTION

This study identifies clinical, behavioural and health system factors influencing CV polypill adoption in South Africa, offering actionable insights to inform research, policy and scalable CVD prevention strategies in LMICs.

MeSH

Antihypertensive Agents, Research, Single-Pill Combination