Client-managed groups

Clinical
Specific populations
Context

"I have found people who support me and understand my status. We meet to share our thoughts and struggle to support each other."

Client, Lesotho

Clients stable on ART form groups of 4-10. They meet at a group member’s home or venue close to all the members’ homes the day before or on the day of the groups’ scheduled facility visit. Each member reports on adherence, and undergoes a pill count and brief symptom screen, which is completed on a group monitoring form. The group may use the opportunity to provide each other with peer support. Each member takes a rotating turn to attend the health care facility for monitoring tests and clinical review whilst collecting ART refills for all members of the group. All members’ ART cards/clinical folders are drawn at the facility and the attending group member reports on the health and adherence of each member from the group monitoring form to the clinician who completes the client ART card/clinical folder. The collecting member thereafter travels home, meets the group at the same venue and distributes collected ART refills. Any group member who is unwell or reports symptoms can attend the facility with the group representative or seek clinical support at any other time.

Who is eligible for this model?

>6 months on ART; >3 months on same regimen; VL < 1000 copies/ml (if VL available) or no current evidence of immunological or clinical failure, no clinical condition requiring more frequent clinical follow-up; adult (>15 years) 

ART refills

WHAT

ART refill
Group adherence support

WHEN

Monthly
2 monthly
3 monthly

WHERE

Community venue
Home

WHO

Client
Peer

Clinical consultation

WHAT

Laboratory tests
ART rescripting
Clinical monitoring
ART refill

WHEN

6 months

WHERE

Primary care clinic

WHO

Nurse
Physician

Summary of the model (per year)

Summary of evidence

Peer-reviewed journal articles from the implementation and outcomes of community ART groups in Mozambique have been published (1,2,3,4,5,9,10,11). Articles include details of client outcomes (retention in care, mortality), and qualitative data from clients and health care workers. Clients receiving care in this model have improved low rates of attrition and mortality.

More detailed evidence can be found here.

Implementation locations/model variations

For more information on specific implementation locations/model variations, click on the location name in the list below. 

Lesotho CAGs
Lesotho
Mozambique national roll out of CAGs
Mozambique
Swaziland CAGs
Swaziland
Zimbabwe
Community ART groups
Kenya
Kampala, Uganda
Zambia CAGs
Magoye, Zambia
Pilot site, Tete province, Mozambique
Tete, Mozambique
Family member refill
Zimbabwe

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More information on how to implement this model. 

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