Distribution of antiretroviral treatment through self-forming groups of patients in Tete province, Mozambique

Abstract

BACKGROUND:: As antiretroviral treatment cohorts continue to expand, ensuring patient retention over time is an increasingly important concern. This, together with capacity and human resource constraints, have led to the consideration of out-of-clinic models for the delivery of antiretroviral therapy (ART). In 2008, Médecins Sans Frontières and the Provincial authorities launched a model of ART distribution and adherence monitoring by community groups in Tete Province, Mozambique. PROGRAMME APPROACH:: Patients who were stable on ART for six months were informed about the community ART group model and invited to form groups. Group members had four key functions: facilitate monthly ART distribution to other group members in the community, provide adherence and social support, monitor outcomes, and ensure each group member undergoes a clinical consultation at least once every six months. Group members visit the health centre on a rotational basis such that each group member has contact with the health service every six months. RESULTS:: Between February 2008 and May 2010, 1,384 members were enrolled into 291 groups. Median follow up time within a group was 12.9 months (8.5-14.1). During this time 83 (6%) were transferred out, and of the 1,301 patients still in community groups, 1,269 (97.5%) were remaining in care, 30 (2%) had died, and 2 (0.2%) were lost to follow-up. DISCUSSION:: The Community ART Group model was initiated by patients to improve access, patient retention, and decongest health services. Early outcomes are highly satisfactory in terms of mortality and retention in care, lending support to such out-of-clinic approaches.