Key result
Cardiovascular polypills show adherence potential in South Africa, but face major barriers to scale-up.
Why the study?
Cardiovascular polypills can improve adherence and outcomes but remain underutilized in South Africa's public sector despite rising CVD burden and inclusion in WHO Essential Medicine List.
Qualitative stakeholder interviews indicate that while cardiovascular polypills have strong potential to improve treatment adherence in South Africa, successful implementation will require coordinated efforts to address systemic barriers, regulatory complexities, and the need for locally relevant evidence.
Barriers to polypill scale-up in South Africa warrant caution against premature adoption; leaves open the need for local trials and policy reforms.
Background Cardiovascular disease (CVD) remains the leading global cause of death, disproportionately affecting low- and middle- income countries (LMICs). Complex treatment regimens compromise adherence and health system delivery. Cardiovascular (CV) polypills, combining a statin with two/three antihypertensives, can improve adherence, risk factor control, and outcomes. However, uptake remains low despite inclusion in the 2023 World Health Organization Essential Medicine List. In South Africa, where CVD and multimorbidity are rising, polypills are unavailable in the public sector, with limited use privately. Understanding stakeholder perspectives is essential to guide implementation. Objective To explore stakeholder perspectives regarding the feasibility, acceptability, and potential uptake of CV polypills in South African primary care. Methods We conducted semi-structured interviews with 15 purposively sampled stakeholders from clinical, policy, regulatory, industry, and advocacy sectors. Data were thematically analysed using ATLAS.ti, with reflexivity, peer debriefing, and participant validation to ensure rigour. Results Participants acknowledged polypill’s potential to improve adherence, simplify treatment, and strengthen prevention, but identified key barriers, including formulation challenges, limited incentives, regulatory complexity, inequitable access, and insufficient local evidence. Pharmacological strategies were viewed as complementary to prevention measures such as risk screening and lifestyle modifications. Participants advocated for context-specific research, coordinated policy action, streamlined regulation, equitable procurement, and advocacy-led demand generation, with government leadership deemed essential. Conclusion CV polypills offer a promising strategy to improve CVD outcomes in LMICs, but impact depends on overcoming systemic barriers and generating local evidence. Coordinated, multisectoral action is critical to achieve scalable and equitable implementation in South Africa and similar settings. Contribution This study advances understanding of the clinical, behavioural, and system-level factors shaping the adoption of CV polypill in South Africa, providing actionable insights to guide future research, inform policy innovation, and support scalable implementation of cardiovascular prevention strategies across LMIC settings.
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Leong et al. (2026) studied Cardiovascular disease (n=15). Cardiovascular polypill was evaluated on Stakeholder perspectives on the feasibility, acceptability, and potential uptake of CV polypills in primary care. Stakeholders acknowledged the cardiovascular polypill's potential to improve adherence and outcomes in South Africa, but identified significant systemic, regulatory, and economic barriers to scale-up.
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