Refill synchronization policies consolidate pharmacy visits for chronic medications, yet their effect on antiretroviral adherence remains contested because exposure is assigned through a deterministic eligibility rule that creates a regression-discontinuity design. Using a design-based power analysis with between-cluster standard deviation of 6.0, residual standard deviation of 4.5, and intraclass correlation of 0.64, power was estimated across 2000 replications per design cell for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. The analysis indicates that 54 clusters are required to detect a 5-percentage-point effect at 80% power, and that the minimum detectable effect declines as cluster count rises. The framework proposes that synchronization operates through three mechanisms—visit consolidation, temporal anchoring, and administrative visibility—that jointly produce adherence bunching at the pharmacy rather than at the patient. The contribution is a design-theoretic account of how a mundane administrative policy becomes a sociological exposure, together with the power parameters that make its evaluation feasible in Namibian primary-care settings.
No takes yet. Share an insight, caveat, or question.
Amutenya et al. (2026) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: