1 / 16

DIRECÇÃO PROVINCIAL DE SAÚDE TETE

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

thina
Download Presentation

DIRECÇÃO PROVINCIAL DE SAÚDE TETE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. Movie ...

  8. Results 1. Characteristics of 1384 members in 291 CAGs on 31/05/10

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. Thank you, Obrigado, Merci , Tatenda

More Related