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

BackgroundCardiovascular 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. ObjectiveTo explore stakeholder perspectives regarding the feasibility, acceptability, and potential uptake of CV polypills in South African primary care. MethodsWe 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. ResultsParticipants acknowledged polypills 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. ConclusionCV 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. ContributionThis 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.