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.