Utilization of and Barriers to HIV and MCH Services among Community ART Group Members and Their Families in Tete, Mozambique

Geelhoed, Diederike; Decroo, Tom; Dezembro, Sergio; Matias, Humberto; Lessitala, Faustino; Muzila, Fausto; Brumana, Luisa; Capobianco, Emanuele

doi:10.1155/2013/937456

Cited by 5 publications

(6 citation statements)

References 12 publications

(15 reference statements)

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“…Overall, the Group of 6 program remained consistent with the primary objectives of the CAG model to improve retention in ART [ 15 , 16 , 31 ]. Eligibility criteria were largely unchanged, and the basic principles of rotational visits to a central health facility to obtain ART for distribution to the entire group were the same.…”

Section: Discussionmentioning

confidence: 79%

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

Naslund

Dionne-Odom

Destine

et al. 2014

AIDS Research and Treatment

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Objective. In Mozambique, a patient-led Community ART Group model developed by Médecins Sans Frontières improved retention in care and adherence to antiretroviral therapy (ART) among persons with HIV. We describe the adaptation and implementation of this model within the HIV clinic located in the largest public hospital in Haiti's Southern Department. Methods. Our adapted model was named Group of 6. Hospital staff enabled stable patients with HIV receiving ART to form community groups with 4–6 members to facilitate monthly ART distribution, track progress and adherence, and provide support. Implementation outcomes included recruitment success, participant retention, group completion of monthly monitoring forms, and satisfaction surveys. Results. Over one year, 80 patients from nine communities enrolled into 15 groups. Six participants left to receive HIV care elsewhere, two moved away, and one died of a non-HIV condition. Group members successfully completed monthly ART distribution and returned 85.6% of the monthly monitoring forms. Members reported that Group of 6 made their HIV management easier and hospital staff reported that it reduced their workload. Conclusions. We report successful adaptation and implementation of a validated community HIV-care model in Southern Haiti. Group of 6 can reduce barriers to ART adherence, and will be integrated as a routine care option.

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Section: Discussionmentioning

confidence: 79%

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

Naslund

Dionne-Odom

Destine

et al. 2014

AIDS Research and Treatment

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“…This approach was based on consultation with the local health services who explicitly wished to avoid the potential programmatic and operational complexity associated with creating “special” clubs for postpartum women separate from the established public sector model of differentiated ART care. However sending postpartum women into the mix of general adult ART patients may not be ideal in all instances, and there are opportunities to provide MCH services within adherence clubs for postpartum women [ 27 ]. Such MCH-focused adherence clubs might include family planning for mothers on ART, infant feeding counselling, and HIV PCR testing as well as vaccinations and anthropometry for infants.…”

Section: Discussionmentioning

confidence: 99%

Differentiated models of care for postpartum women on antiretroviral therapy in Cape Town, South Africa: a cohort study

Myer

Iyun

Zerbe

et al. 2017

Journal of the International AIDS Society

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Background: The numbers of women initiating lifelong antiretroviral therapy (ART) during pregnancy and postpartum is increasing rapidly, presenting a burden on health systems and an urgent need for scalable models of care for this population. In a pilot project, we referred postpartum women who initiated ART during pregnancy to a community-based model of differentiated ART services.Methods: Eligible women (on ART for at least 3 months with viral load (VL)<1000 copies/mL) were offered a choice of two ART models of care: (i) referral to an existing system of community-based ‘adherence clubs’, operated by lay counsellors with medication collection every 2–4 months; or (ii) referral to local primary healthcare clinics (PHC) with services provided by clinicians and medication collection every 1–2 months (local standard of care for postpartum ART). For evaluation, women were followed through 6-months postpartum with VL testing separate from either ART service.Results: Through September 2015, n = 129 women were enrolled (median age, 28 years; median time postpartum, 10 days). Overall, 65% (n = 84) chose adherence clubs and 35% (n = 45) chose PHCs; there were no demographic or clinical predictors of this choice. Location of service delivery was commonly cited as a reason for choice by women selecting either model of care; shorter waiting times, ability to receive ART from lay counsellors and less frequent appointments were motivations for choosing adherence clubs. Among women choosing adherence clubs, 15% never attended the service and another 11% attended the service but were not retained through six months postpartum. Overall, 86% of women (n = 111) remained in the evaluation through 6 months postpartum; in this group, there were no differences in VL<1000 copies/mL at six months postpartum between women choosing PHCs (88%) vs. adherence clubs (92%; p = 0.483), but women who were not retained in adherence clubs were more likely to have VL≥1000 copies/mL compared to those who remained (p = 0.002).Discussion: Adherence clubs may be a valuable model for postpartum women initiating ART in pregnancy, with good short-term outcomes observed during this critical period. To support optimal implementation, further research is needed into patient preferences for models of care, with consideration of integration of maternal and child health services, while ART adherence and retention require ongoing consideration in this population.

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“…Although community ART groups (CAG) established in Tete Province in Mozambique did not include children, 61% of participants in a recent assessment were women of reproductive age and 89% of pregnant CAG members received PMTCT regimens [30]. This platform could provide a unique opportunity to create demand for HTC and treatment among women of reproductive age and their children.…”

Section: Resultsmentioning

confidence: 99%

From patient to person

Hsieh¹,

Rodrigues

Skovdal

et al. 2014

Aids

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Accelerated efforts to end vertical HIV transmission have resulted in a 52% decrease in new infections among children since 2001. However, current approaches to prevent mother-to-child-transmission (PMTCT) assume a linearity and universality. These insufficiently guide clinicians and programmes toward interventions that comprehensively address the varying and changing needs of clients. This results in high levels of loss-to-follow-up at each step of the PMTCT cascade. Current PMTCT approaches must be adapted to respond to the different and complex realities of women, children and families affected by HIV. Drawing on the concept of an 'HIV trajectories,' we screened peer-reviewed literature for promising PMTCT approaches and selected 13 articles for qualitative review when the described intervention involved more than a biomedical approach to PMTCT and mother-child HIV treatment and care. Our qualitative analysis revealed that interventions which integrated elements of the 'HIV trajectories' perspective and built on people living with HIV support/network, community health worker, primary healthcare and early childhood development platforms were successful because they recognized that HIV is an illness, experienced, moderated and managed by numerous factors beyond biomedical interventions alone.On the basis of this review, we call for the adoption of an 'HIV trajectories' perspective that can help assess the comprehensiveness of care provided to women, children and families affected by HIV and can inform the planning and delivery of HIV and related services so that they more adequately respond to the varying needs of clients on different 'HIV trajectories'.

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Utilization of and Barriers to HIV and MCH Services among Community ART Group Members and Their Families in Tete, Mozambique

Cited by 5 publications

References 12 publications

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

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

Differentiated models of care for postpartum women on antiretroviral therapy in Cape Town, South Africa: a cohort study

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