Community ART groups: distribution of ARVs through self-forming groups in Tete province, Mozambique...
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Transcript of Community ART groups: distribution of ARVs through self-forming groups in Tete province, Mozambique...
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