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Community based ART adherence Clubs: A community model of care for ART delivery

Community based ART adherence Clubs: A community model of care for ART delivery. Suhair Solomon, Phumelele Trasada, Gabriela Patten, Fanelwa Gwashu, Lillian Twentiey, Lynne Wilkinson. Background. ~ 6.4 million HIV positive ~ 2.5 million on ART Expansion of ART eligibility, CD4 500

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Community based ART adherence Clubs: A community model of care for ART delivery

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  1. Community based ART adherence Clubs:A community model of care for ART delivery Suhair Solomon, Phumelele Trasada, Gabriela Patten, Fanelwa Gwashu, Lillian Twentiey, Lynne Wilkinson

  2. Background • ~ 6.4 million HIV positive • ~ 2.5 million on ART • Expansion of ART eligibility, CD4 500 • Leaky Cascade Boulle, A. 2014

  3. Setting • Khayelitsha, Cape Town • Population ~ 500,000 • 12 health facilities providing HIV care • 29,192 pts on ART (2014) • 8,552 at Site B CHC (Ubuntu Clinic)

  4. Number of patients retained in Adherence Clubs and % of RIC in club across the Cape Metro ART Adherence Clubs • Stable patients on ART • On ART >12-months • 2 suppressed viral load • No condition requiring frequent clinical consultation • Lay health worker-led • ~30 stable patients • Meets 5 times/year • Receives pre-packed ART • Clear referral pathway for clinical support Club M&E data courtesy of Dr. Beth Harley

  5. Community Models of Care Community venue close to / in patient home Community venue - close to facility Facility

  6. Intervention: community based club • Same club model • Key differences • Patient selected home or venue close to home • Members are from same area • Club facilitator collects treatment at facility or alternative delivery site • Blood visit managed differently • Referral pathway exists but not immediate/dependent on uptake

  7. Methodology • All patients enrolled in CCs in Ubuntu clinic’s feeder areas: May 2012 - November 2014 • Collected • patient baseline characteristics; • longitudinal VL data, • retention in care outcomes (incl. club care) • LTFU = no recorded clinic/club visit >3m.

  8. Results

  9. Results: all patients ever enrolled in community clubs

  10. Results: patients with 1-year follow-up in community clubs Patients 1 year follow-up = 101 LTF 1 (1%) Retained in ART care 100 (99%) Community Club Care 95 (94%) Clinic Care 5 (5%) Due VL 93 (98%) At least 1 VL completed 89 (96%) VL suppressed: 89 (100%)

  11. Conclusion • Homes and community spaces are feasible options • Improves access to ART for patients close to home • High retention and adherence rates • Reduces patient load at health facilities, • Empowers patients through self-management • Reduces community stigma.

  12. Recommendations • Close to home clubs should be considered for rollout elsewhere • Requiring resource planning and management • on a reliable drug supply, • suitable monitoring systems, • trained and supported lay healthcare workers, • effective referral systems and • adequate funding • Consider options for community club scale out (CBO)

  13. https://www.msf.org.za/msf-publications/how-to-keep-art-patients-long-term-care-art-adherence-club-report-and-toolkithttps://www.msf.org.za/msf-publications/how-to-keep-art-patients-long-term-care-art-adherence-club-report-and-toolkit

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