• Adapting a community-based ART delivery model to the patients' needs: a mixed methods research in Tete, Mozambique

      Rasschaert, Freya; Decroo, Tom; Remartinez, Daniel; Telfer, Barbara; Lessitala, Faustino; Biot, Marc; Candrinho, Baltazar; Van Damme, Wim (BioMed Central, 2014-04)
      To improve retention in antiretroviral therapy (ART), lessons learned from chronic disease care were applied to HIV care, providing more responsibilities to patients in the care of their chronic disease. In Tete--Mozambique, patients stable on ART participate in the ART provision and peer support through Community ART Groups (CAG). This article analyses the evolution of the CAG-model during its implementation process.
    • Are Expert Patients an Untapped Resource for ART Provision in Sub-Saharan Africa?

      Decroo, Tom; Van Damme, Wim; Kegels, Guy; Remartinez, Daniel; Rasschaert, Freya; Médecins Sans Frontières, Avenue Eduardo Mondlane 38, Tete, Mozambique. (2012-04)
      Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong condition, requiring lifelong adherence to medication. Reinforcement of self-management through information, acquisition of problem solving skills, motivation, and peer support is expected to allow PLWHA to become involved as expert patients in the care management and to decrease the dependency on scarce skilled medical staff. We developed a conceptual framework to analyse how PLWHA can become expert patients and performed a literature review on involvement of PLWHA as expert patients in ART provision in Sub-Saharan Africa. This paper revealed two published examples: one on trained PLWHA in Kenya and another on self-formed peer groups in Mozambique. Both programs fit the concept of the expert patient and describe how community-embedded ART programs can be effective and improve the accessibility and affordability of ART. Using their day-to-day experience of living with HIV, expert patients are able to provide better fitting solutions to practical and psychosocial barriers to adherence. There is a need for careful design of models in which expert patients are involved in essential care functions, capacitated, and empowered to manage their condition and support fellow peers, as an untapped resource to control HIV/AIDS.
    • Community-based antiretroviral therapy programs can overcome barriers to retention of patients and decongest health services in sub-Saharan Africa: a systematic review

      Decroo, Tom; Rasschaert, Freya; Telfer, Barbara; Remartinez, Daniel; Laga, Marie; Ford, Nathan; Médecins Sans Frontières, Av. Eduardo Mondlane 38 - CP 262, Tete, Mozambique. (Oxford University Press, 2013-09-05)
      In sub-Saharan Africa models of care need to adapt to support continued scale up of antiretroviral therapy (ART) and retain millions in care. Task shifting, coupled with community participation has the potential to address the workforce gap, decongest health services, improve ART coverage, and to sustain retention of patients on ART over the long-term. The evidence supporting different models of community participation for ART care, or community-based ART, in sub-Saharan Africa, was reviewed. In Uganda and Kenya community health workers or volunteers delivered ART at home. In Mozambique people living with HIV/AIDS (PLWHA) self-formed community-based ART groups to deliver ART in the community. These examples of community ART programs made treatment more accessible and affordable. However, to achieve success some major challenges need to be overcome: first, community programs need to be driven, owned by and embedded in the communities. Second, an enabling and supportive environment is needed to ensure that task shifting to lay staff and PLWHA is effective and quality services are provided. Finally, a long term vision and commitment from national governments and international donors is required. Exploration of the cost, effectiveness, and sustainability of the different community-based ART models in different contexts will be needed.
    • Positive spill-over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi

      Rasschaert, Freya; Pirard, Marjan; Philips, Mit P; Atun, Rifat; Wouters, Edwin; Assefa, Yibeltal; Criel, Bart; Schouten, Erik J; Van Damme, Wim (2011)
    • A qualitative assessment of a community antiretroviral therapy group model in Tete, Mozambique

      Rasschaert, Freya; Telfer, Barbara; Lessitala, Faustino; Decroo, Tom; Remartinez, Daniel; Biot, Marc; Candrinho, Baltazar; Mbofana, Francisco; Van Damme, Wim (Public Library of Science, 2014-03-20)
      To improve retention on ART, Médecins Sans Frontières, the Ministry of Health and patients piloted a community-based antiretroviral distribution and adherence monitoring model through Community ART Groups (CAG) in Tete, Mozambique. By December 2012, almost 6000 patients on ART had formed groups of whom 95.7% were retained in care. We conducted a qualitative study to evaluate the relevance, dynamic and impact of the CAG model on patients, their communities and the healthcare system.
    • Short and long term retention in antiretroviral care in health facilities in rural Malawi and Zimbabwe.

      Rasschaert, Freya; Koole, Olivier; Zachariah, Rony; Lynen, Lut; Manzi, Marcel; Van Damme, Wim; Institute of Tropical Medicine, Nationale straat 155, Antwerpen 2000, Belgium. frasschaert@itg.be (2012-12)
      Despite the successful scale-up of ART services over the past years, long term retention in ART care remains a major challenge, especially in high HIV prevalence and resource-limited settings. This study analysed the short (<12 months) and long (>12 months) term retention on ART in two ART programmes in Malawi (Thyolo district) and Zimbabwe (Buhera district).
    • Sustainability of a community-based anti-retroviral care delivery model - a qualitative research study in Tete, Mozambique

      Rasschaert, Freya; Decroo, Tom; Remartinez, Daniel; Telfer, Barbara; Lessitala, Faustino; Biot, Marc; Candrinho, Baltazar; Van Damme, Wim (International AIDS Society, 2014-10-06)
      To overcome patients' reported barriers to accessing anti-retroviral therapy (ART), a community-based delivery model was piloted in Tete, Mozambique. Community ART Groups (CAGs) of maximum six patients stable on ART offered cost- and time-saving benefits and mutual psychosocial support, which resulted in better adherence and retention outcomes. To date, Médecins Sans Frontières has coordinated and supported these community-driven activities.