Hiv self help groups may increase retention in care in mozambique
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HIV Self-help groups may increase retention in care in Mozambique. Sabrina Pestilli , Jara Llenas-García , Erling Larsson, Michael Hobbins , Jochen Ehmer , Philip Wikman . IAS 2013. Background. Loss to follow-up is the most common cause of attrition (56%)¹

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Hiv self help groups may increase retention in care in mozambique

HIV Self-help groups may increase retention in care in Mozambique

Sabrina Pestilli,

JaraLlenas-García,

Erling Larsson,

Michael Hobbins,

JochenEhmer,

Philip Wikman.

IAS 2013


Background

Background Mozambique

Loss to follow-up is the most common cause ofattrition (56%)¹

Logistical challenges cause defaulting fromART ² :

distance to services

transport cost

work and family responsibilities

Barriers at the health centre lead to defaulting fromcare³:

long waiting time

lack of support and information

poorqualityof the health services

 Self help groups of HIV patients appear to increase retention in care while decreasing financial/logistic/social barriers to care 4

¹ Fox et al. Trop Med Int Health 2010; ² Geng et al JAIDS 1999;³ Miller at al Trop Med IntHealth2010; 4Decroo et al JAIDS 2011


Objectives

Objectives Mozambique

To evaluate the feasibility of Self-Help Groups (SHG) of HIV+ people in a secluded area of Northern Mozambique

To evaluate the retention into care of HIV+ people in SHG vs. HIV+ people not in SHG


Context

Context Mozambique

Chiure district, Cabo Delgado

~ 250,000 inhabitants

11 Health Centres

1 health staff/ 5,812 people

3 health centres providing ART, 2 of them initiating ART

Chiure


Hiv in the chiure district

HIV in the Chiure District Mozambique

HIV prevalence: 4%¹

Estimated number of HIV+ individuals: 8,472

In need of ART: 3,122

Enrolled in ART: 1,242 pts

Attrition rate 32% ²

²Provincial Health Directorate 2011

¹ Provincial Health Directorate 2012


Health centre conditions

Health Centre Conditions Mozambique

Lack of health staff

Distant

Poor management

«Quantity vs. Quality»


Health centre conditions1

Health Centre Conditions Mozambique

Lack of health staff

Distant

Poor management

«Quantity vs. Quality»

  • HIV patients on treatment:

  • With HIV treatment experience

  • Without signs of complications

  • should not frequent the health centre every month to fetch pills


Hiv self help group

HIV MozambiqueSelf Help Group

A group of up to 6 members (HIV+ patients in treatment) with 1 focal point

SHG members:

1. Rotationally collect ART drugs in HC and distribute to others

2. Monitor other members adherence/outcomes

3. Provide social support

4. Have a clinical consultation/CD4 every 6 months

Focal point:

1. Coordinate with the HC

2. Monitor members adherence and health

3. Organize a SHG meeting once per month


Hiv self help group1

HIV MozambiqueSelf Help Group

Criteria to form SHG:

1. 2-6 pts living in the same community or geographic area

2. Patients≥16 years

3. Ptsstable on treatment ≥6 months

4. Pts clinically stable

5. CD4 count > 200 cell/ul

6. Pts in first line

7. Motivation to be in SHG


  • Potential Mozambiquebenefits ¹:

  • Timesavings (patient and health staff)

  • Money savingforpts (lesstripsto the healthcentres)

  • Efficiencyofhealthcentrevisit

  • Stigma reduction

  • Reductionofattrition

  • Risks:

  • Decreasing treatment quality and follow up

  • Needs regular monitoringvisitsfromhealth staff toensurequality

  • ¹Decrooet al JAIDS 2011


Method

Method Mozambique

Participants:

From March 2011 – December 2012:

 27 groups with 140 pts

Inclusion Criteria:

≥16 years of age

On ART ≥6 months (a pre-requisite to be included in SHG).

Method for Analysis

Retrospective comparison of HIV+ patients on ART using same inclusion criteria for SHG and non-SHG group

Fisher exact test for the categorical variables comparison

Student-t-test or Mann-Whitney-U-test for the continuous variables comparison


Results characteristics

Results: Characteristics Mozambique

  • Gender imbalance between SHG and Non-SHG


Results outcome

Results: Outcome Mozambique

  • Outcome (death) is similar betweengroups

  • Significantly less LTFU in the SHG

  • Significantly less time of follow upduringthe same time period in the Non-SHG


Conclusions

Conclusions Mozambique

SHG strategy was wellaccepted

Exit rate from SHG is low 13.6% ( 2 LFU, 6 deaths, 8 pregnancy,1 TB, 1 in 2ndline,1 epilepsy)

Retention in care appears improved, but

Selection bias is likely to contribute to the seen effect

Demand in the neighbouring communities increase!

The pilotedstrategyhas now been expanded to every district in Cabo Delgado province and nationwide.


Acknowledgements

Acknowledgements Mozambique

Allpatients and staff in Chiure

ColleaguesfromSolidarMedMozambique (J. Garcia, P. Wikman, E.Larsson)

ColleaguesfromSolidarMedLucerne (J. Ehmer, M. Hobbins)


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