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gaAc strategy grupos de apoio a adesÃo comunitÁria Community adherence SuPPORT groups

Ministry of Health, Mozambique. gaAc strategy grupos de apoio a adesÃo comunitÁria Community adherence SuPPORT groups. MSF-OCB, Mozambique. Rome, 17 th of July 2011. Mozambique. HIV Prevalence: 11,5% (INSIDA 2009) 30% Population without access to health (PES,2007)

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gaAc strategy grupos de apoio a adesÃo comunitÁria Community adherence SuPPORT groups

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  1. Ministry of Health, Mozambique gaAc strategygrupos de apoio a adesÃo comunitÁriaCommunity adherence SuPPORT groups MSF-OCB, Mozambique Rome, 17th of July 2011

  2. Mozambique • HIV Prevalence: 11,5% (INSIDA 2009) • 30% Population without access to health (PES,2007) • 1 in 5 HFs has ART (245 Total ART HFs) • Need for 7 X more HRH as compared to minimal WHO recommendations ( 2010) • 30 % ART coverage (WHO, end 2009) • ~ 50 % LTFU ART at 3 years (CDC, not published) • Tete Province: April 2009, Partner initiative • Average time in GAAC: 13,2 months • 3.530 members formed 788 GAACs

  3. Strategy • GAAC (Community Adherence Support Groups) A model of community-based ART distribution and adherence monitoring by self-forming groups of patients on ART • Primary Objective • To improve retention in care of patients on ART through increasing patient involvement • Secondary Objectives • To improve access, retention and adherence of patients on ART. • To enhance the quality of the services and follow-up of patients at the HF. • To establish a system of early surveillance to triage medical conditions and situations related to LTFU. • To reduce the number of clinical appointments and the workload at the HF. • To reinforce the psychosocial support among ART and pre-ART patients. • To strengthen the link between the HF and the community.

  4. Strategy 3 Member 1 goes home while members 2, 3, 4, 5 and 6 conduct GAAC trips to HF during the following five months GAAC in the community Feb Mar Apr May Jun Home Member 1 returns to community and distributes ARVs to other 5 GAAC members 2 January 1 E A D C B GAAC member 1 goes to HF every six months for clinical consultation, psychosocial counseling, lab tests and to pick up monthly GAAC ARVs Laboratory Reception Consultation Pharmacy Counselor Health Facility

  5. National Pilot: Methods Pilot HF selection • 3 Health Facilities in each province selected – 1 health facility from each of three patient volume categories: • Each health facility required to provide a minimum package of services • ART program for more than 6 months • 2 staff (clinician, nurse) • CD4 testing • TB services

  6. National Pilot: Methods Patient Inclusion Criteria • On ART for at least 6 months, good adherence • Age ≥ 15 years OR children on adult ART dosage • CD4 count ≥ 200 cel/ul and clinically stable • Interest in involvement in GAAC

  7. National Pilot: Methods Criteria for Group Formation • 2- 6 members • Group is established according to social or cultural affinities related to location, employment or other kind of relationship • Each group will be formed by members that selects a Focal Point responsible for some of the main activities of the group • Group rotation

  8. National Pilot: Roles 1. Tasks of GAAC Focal Point (within each group) • Coordination with the HF • Monitor & report adherence to the treatment of each group member • Monthly meetings with his group (including one the day before going to the HF) • Defaulter tracing • Remind group members to go to the HF every 6 months • Refer patients whose condition requires medical attention • Stimulate the group to create a fund to support travel to the HF

  9. National Pilot: Roles 2. Tasks of GAAC Members Be representative of the group every 6 months for: • Pick up ARVs & distribute to rest of the group • Report adherence and health status of group members • Medical appointment every 6 months • Support group members for adherence to treatment • Refer patients whose condition requires medical attention • Home visits • Conduct educational sessions within community (HIV prevention, stigma)

  10. National Pilot: Roles 3. Tasks of GAAC Focal Point (nurse) at the HF • Sensitize patients on GAAC • Clinically assess for eligibility for GAAC • Coordination with GAACs • Train the focal points and members of the GAACs on HIV/AIDS, Ois, CD4, reporting and other aspects of the management group. • Monthly follow up and monitoring the adherence on the GAAC • Monitor and follow up patients with low CD4 counts, poor adherence, anemia and other aspects relating to ART. • File management of GAACs • Provide M&E, IEC materials to the focal point

  11. National Pilot: M&E Proposed M&E Tools • ARVs Control Register: To register monthly patient pill-counts and report warnings of potential OIs (filled out in the GAAC community) • GAAC Register Book: To register and follow up information about the group members (including basic demographic and treatment follow-up information) • GAAC Monthly Report: To track GAAC expansion and trends in GAAC patient retention at the HF, district, provincial and national level

  12. Obrigada !!

  13. Thank you!

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