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DIRECÇÃO PROVINCIAL DE SAÚDE TETE. 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. Background - HIV in Tete province

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DIRECÇÃO PROVINCIAL DE SAÚDE TETE


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slide1

DIRECÇÃO PROVINCIAL DE SAÚDE TETE

Community ART groups: distribution of ARVs through self-forming groups in Tete province, MozambiqueTom Decroo, Barbara Telfer, Jacob Maïkéré, Sergio Dezembro, Carla das Dores, Marc Biot and Nathan Ford

slide2

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
slide3

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

slide4
Community ART groups (CAG)

Objective: improve retention

by

  • Addressing patient reported barriers5
  • Involvement of patients
    • Distribute ARVs in community
    • Assess adherence & outcomes
  • Dissociate care & ARV refills
slide5

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
slide6

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
results 2 outcomes of 1384 members in 291 cags on 31 05 10
Results 2. Outcomes of 1384 members in 291 CAGs on 31/05/10
  • 1384 members > 14 years of age
  • 83 transferred out(35 to another HF)
  • remain 1.301
slide10

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
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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
slide12

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
slide13

References

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