Community ART groups: distribution of ARVs through

self-forming groups in Tete province, Mozambique

Tom Decroo, Barbara Telfer, Jacob Maïkéré, Sergio Dezembro, Carla das Dores, Marc

Biot and Nathan Ford

DIRECÇÃO PROVINCIAL DE SAÚDE TETE

Background - HIV in Tete province

HIV prevalence 13% in 2007 (11%-21%)1

Gap Human Resources for Health2

National ART coverage of 31%3

Up to 1 on 5 on ARV is lost to follow up, 50% dead4

Barriers to access ARV5:• distances/ transport• waiting times in Health Facility • social obligations

Self management and expert patients

Use day-to-day experience of patients

Train them to assume standardized functions such as ARV provision

Kober & Van Damme6

Community ART groups (CAG)

Objective: improve retentionby Addressing patient

reported barriers5

Involvement of patients• Distribute ARVs in

community• Assess adherence &

outcomes

Dissociate care & ARV refills

Method (1/2): implementation of CAGs

Consult stakeholders Patients self form groups of six Inclusion criteria: 1st line, time on

ART, CD4 Inscription on a group monitoring form Monthly: group-refill by representative 6 monthly: consult, CD4 and training

Method (2/2): descriptive analysis

Sources for monitoring and verification: Group monitoring forms Clinical files Observation of patient at CAG

meetings Home visits Data entered and analyzed in Excel

and STATA

Movie ...

Results 1. Characteristics of 1384 members in 291 CAGs on 31/05/10

Nr [IQR]

Median age (years) at enrolment 36 [30 - 43]

Median months on ART pre CAG 22 [10 – 34]

Median CD4 at ART initiation (nr = 1298)

176 [105 - 247]

Median months in CAG 13 [9 – 14]

Members > 9 months in CAGWith a last CD4 in last 9 monthsMedian CD4

1069836479

[314 - 642]

Results 2. Outcomes of 1384 members

in 291 CAGs on 31/05/10

Nr %

total- Dead- Lost to follow up- Retained in CAG

1301302

1269

100 %2.3 %0.2 % 97.5

%

1384 members > 14 years of age 83 transferred out (35 to another HF) remain 1.301

Discussion – limitations

Difficult to compare with ART cohorts in conventional care

Limited follow up time of 13 months Reduced contact with clinicians Potential for abuse

Conclusion

ART retention possible with patients as partners in care delivery

Patients in Community ART groups can:• Support each other• Distribute ARVs• Monitor adherence & outcomes

Way forward:• Evaluation of the CAG model • MOH promoted implementation

Acknowledgements

Patients Vision: Wim Van Damme

Tete authorities: Luisa Isabel Cumba, Carla dos Dores and Azélia Novéla

Implementation: Mariano, Helena, Natasha, Laura, Déolinda, counselors (Augusto, Dinda, Sonia, Ana, Raja, Julio, Marcelino, Jose, Lourenco, Maria, Viola)

Technical advice: Kathryn Chu and Katharina Hermann

Film: Eliane Beeson, Paul Kelso

References1. Grupo técnico multisectorial de apoio a luta contra o HIV/SIDA em

Moçambique. Ronda de Vigilância. Epidemiológica do HIV de 2007. Republica de Moçambique, Ministério da Saúde, Direcção Nacional da Assistência Medica. Programa Nacional de Controle das ITS/HIV/SIDA. Maputo, Fevereiro de 2008.

2. UNAIDS/WHO. Epidemiological Fact Sheet on HIV and AIDS. Mozambique. September 2008.

3. Oooms, G., Van Damme, W., Temmerman, M. (2007). Medicines without Doctors: Why the Global Fund must fund salaries of health workers to expand AIDS treatment. PLoS Medicine, Vol 4; Issue 4: 605-608.

4. Caluwaerts, C., Maendaenda, R., Maldonado, F., Biot, M., Ford, N., Chu, K. (2009) Risk factors and true outcomes for lost to follow-up individuals in an antiretroviral treatment programme in Tete, Mozambique. International Health, 1: 97-101.

5. Posse, M. & Baltussen, R. (2009). Barriers to access to antiretroviral treatment in Mozambique, as perceived by patients and health workers in urban and rural settings. AIDS patient care, Vol 23, no.10: 867-875.

6. Kober, K. & Van Damme, W. (2006) Expert patients and AIDS care. A literature review on expert programmes in high-income countries, and an exploration of their relevance for HIV/AIDS care in low-income countries with severe human resource shortages. In Eldis. (Ed.) (pp. 1-27). Antwerp: Eldis. www.eldis.org/hivaids/fulltext/kober-vandamme.pdf

Thank you, Obrigado, Merci , Tatenda