Implementation of community‐based adherence clubs for stable antiretroviral therapy patients in Cape Town, South Africa. Issue 1 (27th May 2015)

• Record Type: Journal Article
• Authors: Grimsrud, Anna; Sharp, Joseph; Kalombo, Cathy; Bekker, Linda‐Gail; Myer, Landon
• Is Part Of: Journal of the International AIDS Society. Volume 18:Issue 1(2015)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2015-05-27
• Subjects: models of care -- ART delivery -- community‐based -- loss to follow‐up -- decentralization -- task shifting; AIDS (Disease) -- Periodicals; HIV infections -- Periodicals; 616.9792005
• DOI: 10.7448/IAS.18.1.19984
• Languages: English
• ISSNs: 1758-2652

Abstract

Abstract : Introduction: Community‐based models of antiretroviral therapy (ART) delivery have been recommended to support ART expansion and retention in resource‐limited settings. However, the evidence base for community‐based models of care is limited. We describe the implementation of community‐based adherence clubs (CACs) at a large, public‐sector facility in peri‐urban Cape Town, South Africa. Methods: Starting in May 2012, stable ART patients were down‐referred from the primary care community health centre (CHC) to CACs. Eligibility was based on self‐reported adherence, >12 months on ART and viral suppression. CACs were facilitated by four community health workers and met every eight weeks for group counselling, a brief symptom screen and distribution of pre‐packed ART. The CACs met in community venues for all visits including annual blood collection and clinical consultations. CAC patients could send a patient‐nominated treatment supporter ("buddy") to collect their ART at alternate CAC visits. Patient outcomes [mortality, loss to follow‐up and viral rebound (>1000 copies/ml)] during the first 18 months of the programme are described using Kaplan–Meier methods. Results and Discussion: From June 2012 to December 2013, 74 CACs were established, each with 25–30 patients, providing ART to 2133 patients. CAC patients were predominantly female (71%) and lived within 3 km of the facility (70%). During the analysis period, 9 patients in a CAC died (<0.1%), 53 were up‐referred for clinical complications (0.3%) and 573 CAC patients sent a buddy to at least one CAC visit (27%). After 12 months in a CAC, 6% of patients were lost to follow‐up and fewer than 2% of patients retained experienced viral rebound. Conclusions: Over a period of 18 months, a community‐based model of care was rapidly implemented decentralizing more than 2000 patients in a high‐prevalence, resource‐limited setting. The fundamental challenge for this out of facility model was ensuring that patients receiving ART within a CAC were viewed as an extension of the facility and part of the responsibility of CHC staff. Further research is needed to support down‐referral sooner after ART initiation and to describe patient experiences of community‐based ART delivery.