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Original Research
Stakeholder perspectives on the feasibility and uptake of the cardiovascular polypill in South Africa
Submitted: 30 October 2025 | Published: 06 August 2026
About the author(s)
Trudy D. Leong, Health Systems Research Unit, South African Medical Research Council, Parow Valley, South Africa; and, Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Stellenbosch, South AfricaBey-Marrie Schmidt, Health Systems Research Unit, South African Medical Research Council, Parow Valley, South Africa; and, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
Liesel Zühlke, Office of the President, South African Medical Research Council, Parow Valley, South Africa
Robyn Curran, Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
Jane Simmonds, Office of the President, South African Medical Research Council, Parow Valley, South Africa
Ntobeko A.B. Ntusi, Office of the President, South African Medical Research Council, Parow Valley, South Africa; and, Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
Tamara Kredo, Health Systems Research Unit, South African Medical Research Council, Parow Valley, South Africa; and, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
Lara Fairall, Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa; and, 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.
Keywords
Sustainable Development Goal
Metrics
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