Community-Based ART Resulted in Excellent Retention and Can Leverage Community Empowerment in Rural Lesotho, A Mixed Method Study
DOI:
https://doi.org/10.17140/HARTOJ-2-107Keywords:
HIV, Antiretroviral therapy, Highly active, Health services accessibility, Peer support, Community participationAbstract
Objectives: We conducted a mixed method study to evaluate the pilot of community ART groups (CAG’s) in Lesotho.
Method: At the end of 2012 CAGs were piloted in Nazareth clinic, a facility in rural Lesotho. In CAG’s stable patients take turns to collect antiretroviral therapy (ART) for fellow group members. Kaplan-Meier techniques were used to estimate retention among stable patients in CAG and not in CAG. Eight focus group discussions with 40 purposively selected CAG members, nine village health workers, six community leaders and nine clinicians provided insights in how CAGs are perceived by different stakeholders. The thematic analysis approach was employed for data analysis.
Results: Among 596 stable patients 199 (33%) had joined a CAG. One year retention among CAG members and patients not in CAG was 98.7% (95% CI, 94.9-99.7) and 90.2% (95% CI, 86.6-92.9) respectively. CAG members commented that membership in CAG: 1) reduced time, effort, and money spent to get a monthly ART refill; 2) induced peer support, which enhanced adherence, socio-economic support and empowered members to deal with stigma; and 3) resulted in a feeling of relief and comfort. Village health workers confirmed increased openness about HIV in their community. Community leaders added that CAG members promoted health
seeking behaviour to community members. Clinicians reported a workload reduction.
Conclusion: Participation in CAG impacted positively on the lives of members, not only on their access to ART, but also on their life within the community.
References
World Health Organisation. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infec-tion. Recommendations for a public health approach. Geneva, Switzerland: 2013.
UNAIDS 2014. Global Report. UNAIDS report on the global AIDS epidemic 2013.
Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007-200: systematic review. Trop Med Int Health. 2010; 15: 1-15. doi: 10.1111/j.1365-3156.2010.02508.x
Govindasamy D, Ford N, Kranzer K. Risk factors, barri-ers and facilitators for linkage to antiretroviral therapy care: a systematic review. AIDS. 2012; 26: 2059-2067. doi: 10.1097/ QAD.0b013e3283578b9b
Worldbank. World Development Indicators. 2012. Available at: http://data.worldbank.org/country/lesotho Accessed on 21 November 2013.
Wandeler G, Keiser O, Pfeiffer K, et al. Outcomes of anti-retroviral treatment programs in rural Southern Africa. J Ac-quir Immune Defic Syndr. 2012; 59: e9-e16. doi: 10.1097/ QAI.0b013e31823edb6a
Lesotho Doctors. Statistics from the health sector. 2013. Available at http://www.lesothodoctors.com Accessed on 21 November 2013.
Decroo T, Telfer B, Biot M, et al. Distribution of antiretro-viral treatment through self-forming groups of patients in Tete Province, Mozambique. J Acquir Immune Defic Syndr. 2011; 56: e39-e44. doi: 10.1097/QAI.0b013e3182055138
Decroo T, Koole O, Remartinez D, et al. (2014) Four year retention and risk factors for attrition among members of com-munity ART groups in Tete, Mozambique. Trop Med Int Health. 2014; 19: 514-521. doi: 10.1111/tmi.12278
Lesotho Ministry of Finance. Census Preliminary Results. 2006. Available at http://www.finance.gov.ls/data/Census_Pre-liminary_Results.pdf. Accessed on 12 November 2014.
Rasschaert F, Telfer B, Lessitala F, et al. A qualitative assess-ment of a community antiretroviral therapy group model in Tete, Mozambique. PLoS One. 2014; 9: e91544. doi: 10.1371/journal. pone.0091544
Bemelmans M, Baert S, Goemaere E, et al. Community-supported models of care for people on HIV treatment in sub-Saharan Africa. Trop Med Int Health. 2014; 19: 968-977. DOI: 10.1111/tmi.12332
Decroo T, Rasschaert F, Telfer B, et al. Community-based antiretroviral therapy programs can overcome barriers to reten-tion of patients and decongest health services in sub-Saharan Africa: a systematic review. Int Health. 2013; 5: 169-179. doi: 10.1093/inthealth/iht016
World Health Organization. Supplement to the 2013 con-solidated guidelines on the use of antiretroviral drugs for treat-ing and preventing HIV infection: recommendations for a public health approach. Geneva, Switzerland: 2014.
Van Damme W, Kober K, Kegels G. Scaling-up antiretrovi-ral treatment in Southern African countries with human resource shortage: how will health systems adapt? Soc Sci Med. 2008; 66: 2108-2121. doi: 10.1016/j.socscimed.2008.01.043
Rasschaert F, Decroo T, Remartinez D, et al. Sustainabil-ity of a community-based anti-retroviral care delivery model - a qualitative research study in Tete, Mozambique. J Int AIDS Soc. 2014; 17: 18910. doi: 10.7448/IAS.17.1.18910
Luque-Fernandez MA, Van Cutsem G, Goemaere E, et al. Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa. PLoS One. 2013 ;8: e56088. doi: 10.1371/ journal.pone.0056088
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in HIV/AIDS Research and Treatment (HRT) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
