Adapting and Implementing a Community Program to Improve Retention in Care among Patients with HIV in Southern Haiti: “Group of 6”

Naslund, John A.; Dionne-Odom, Jodie; Destine, Cleonas Junior; Jogerst, Kristen; Senecharles, Redouin; Louis, Michelande Jean; Desir, Jasmin; Ledan, Yvette Néptune; Beauséjour, Jude Ronald; Charles, Roland; Werbel, Alice; Talbot, Elizabeth A.; Joseph, Patrice; Pape, Jean William; Wright, Peter F.

doi:10.1155/2014/137545

Cited by 19 publications

(24 citation statements)

References 23 publications

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“…This evaluation suggests that the CARG model can be successfully implemented on a broad scale with lower levels of external support than previous pilot studies. Unlike past pilot programmes, facilities included in this evaluation had no staff dedicated to implementing CARGs and lacked the resources to routinely conduct community visits to CARG members [13,15,20,21]. Yet, our results are consistent with findings from evaluations of pilot programmes [12,20,22], and these results bode well for other countries implementing the CAG/ CARG model nationally.…”

Section: Discussionsupporting

confidence: 83%

“…In the CAG model, ART clients form into groups, and group members take turns collecting ART for all members, reducing the frequency of clinic visits. Regional and national pilots in Mozambique found higher rates of retention among CAG members [10,11], and qualitative analyses and satisfaction surveys indicated positive acceptance by ART clients and healthcare workers [12][13][14][15]. These findings have led several Ministries of Health to recently incorporate the CAG model into their national guidelines [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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The rollout of Community ART Refill Groups in Zimbabwe: a qualitative evaluation

Bochner

Meacham

Mhungu³

et al. 2019

J Intern AIDS Soc

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Introduction Community ART Refill Groups (CARGs) are an antiretroviral therapy (ART) delivery model where clients voluntarily form into groups, and a group member visits the clinic to collect ART for all group members. In late 2016, Zimbabwe began a nationwide rollout of the CARG model. We conducted a qualitative evaluation to assess the perceived effects of this new national service delivery model. Methods In March‐June 2018, we visited ten clinics implementing the CARG model across five provinces of Zimbabwe and conducted a focus group discussion with healthcare workers and in‐depth interviews with three ART clients per clinic. Clinics had implemented the CARG model for approximately one year. All discussions were audio recorded, transcribed, and translated into English, and thematic coding was performed by two independent analysts. Results In focus groups, healthcare workers described that CARGs made ART distribution faster and facilitated client tracking in the community. They explained that their reduced workload allowed them to provide better care to those clients who did visit the clinic, and they felt that the CARG model should be sustained in the future. CARG members reported that by decreasing the frequency of clinic visits, CARGs saved them time and money, reducing previous barriers to collecting ART and improving adherence. CARG members also valued the emotional and informational support that they received from other members of their CARG, further improving adherence. Multiple healthcare workers did express concern that CARG members with diseases that begin with minor symptoms, such as tuberculosis, may not seek treatment at the clinic until the disease has progressed. Conclusions We found that healthcare workers and clients overwhelmingly perceive CARGs as beneficial. This evaluation demonstrates that the CARG model can be successfully implemented on a national scale. These early results suggest that CARGs may be able to simultaneously improve clinical outcomes and reduce the workload of healthcare workers distributing ART.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

The rollout of Community ART Refill Groups in Zimbabwe: a qualitative evaluation

Bochner

Meacham

Mhungu³

et al. 2019

J Intern AIDS Soc

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“…An evaluation of MSF’s strategies concluded that they “lightened the burden for both patients (reduced travel and lost income) and health system (reduced clinic attendance)” [13]. Similar studies from Haiti, Mozambique, Tanzania, Zambia, and Uganda support the efficacy of community-supported distribution [14–16]. Linking HIV diagnosis (including the use of rapid diagnostics) with home- or community-based ART initiation offers further opportunity for increased coverage: a randomized trial of 16,660 Malawian adults documented a significant increase in the rate of ART initiation among those who were offered optional home initiation of HIV care after HIV self-testing (OraQuick ADVANCE® Rapid HIV-1/2 antibody test, OraSure Technologies) as compared with those offered only facility-based services after self-testing [17].…”

Section: Principles Of Community-based Therapymentioning

confidence: 98%

Community-Based ART Programs: Sustaining Adherence and Follow-up

et al. 2016

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The advent of antiretroviral therapy (ART) in 1996 brought with it an urgent need to develop models of health care delivery that could enable its effective and equitable delivery, especially to patients living in poverty. Community-based care, which stretches from patient homes and communities—where chronic infectious diseases are often best managed—to modern health centers and hospitals, offers such a model, providing access to proximate HIV care and minimizing structural barriers to retention. We first review the recent literature on community-based ART programs in low- and low-to-middle-income country settings and document two key principles that guide effective programs: decentralization of ART services and long-term retention of patients in care. We then discuss the evolution of the community-based programs of Partners In Health (PIH), a nongovernmental organization committed to providing a preferential option for the poor in health care, in Haiti and several countries in sub-Saharan Africa, Latin America, Russia and Kazakhstan. As one of the first organizations to treat patients with HIV in low-income settings and a pioneer of the community-based approach to ART delivery, PIH has achieved both decentralization and excellent retention through the application of an accompaniment model that engages community health workers in the delivery of medicines, the provision of social support and education, and the linkage between communities and clinics. We conclude by showing how PIH has leveraged its HIV care delivery platforms to simultaneously strengthen health systems and address the broader burden of disease in the places in which it works.

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“…However, several previous studies conducted in Haiti showed an improvement in HIV care and ART adherence associated with group members support (Naslund et al, 2014;Kimmel et al, 2013;Severe et al, 2010). These outcomes suggest further investigations are needed to determine the components which may contribute the most to improved adherence.…”

Section: Research Questionsmentioning

confidence: 90%

“…It is possible that an improved sense of peer-support and having an environment to confidentially discuss their experience with HIV may have increased adherence in this sample (Rasschaert et al, 2014;Naslund et al, 2014;Allen et al, 2011).…”

Section: Hypothesis 3bmentioning

confidence: 95%

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

Jean¹

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DEDICATIONThis dissertation is dedicated to my parents Lionel and Maud Jean for all the sacrifices that they made so that my siblings and I could have all the opportunities in order to live a fulfilled life. This is also dedicated to my grandparents for teaching me about the role of family and about faith. Most importantly, this is dedicated to Haiti and the people of Haiti, for teaching me about perseverance and how to overcome adversities.

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Adapting and Implementing a Community Program to Improve Retention in Care among Patients with HIV in Southern Haiti: “Group of 6”

Cited by 19 publications

References 23 publications

The rollout of Community ART Refill Groups in Zimbabwe: a qualitative evaluation

The rollout of Community ART Refill Groups in Zimbabwe: a qualitative evaluation

Community-Based ART Programs: Sustaining Adherence and Follow-up

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

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