Model mechanics

ART refills

Clinical consultations

Individual/group approach

Group – group leader collects on behalf of the group and distributes

Individual – group attends community drug distribution point (CDDP) on same day and each group member is seen by mobile outreach team

Who attends?

Group leader

Client

Client recruitement

Where

At facility and CDDP (in community)

By whom

Clinician and counsellor at facility
Lay health care worker who runs CDDP

Eligibility assessment

Clinician and counsellor at facility. Client consent sought by lay health care worker at CDDP

Group formation

Lay health care worker together with CDDP patients

HIV disclosure

Does it happen?

Yes

If yes, where?

Within the group

Annual health care visit schedule for client

2-month community ART refill, bi-annual clinical consultations:

  1. ART refill (in community)
  2. ART refill (in community)
  3. ART refill + blood draw + clinical review + rescript (in community at CDDP)
  4. ART refill (in community)
  5. ART refill (in community)
  6. ART refill + blood draw + clinical review + rescript (in community at CDDP)

3-month community ART refill, bi-annual clinical consultations:

  1. ART refill (in community)
  2. ART refill + blood draw + clinical review + rescript (in community at CDDP)
  3. ART refill (in community)
  4. ART refill + blood draw + clinical review + rescript (in community at CDDP)

(2016 in process of changing from 2-month to 3-month schedule)

Alignment of ART refill and blood draw visit

Does it happen?

Yes. ART refill and blood drawn on same day as clinical visit

Aligment of ART refill and clinical visits

Does it happen?

Yes. ART refills and clinical visits are done on the same day

Strategy and timing for actioning high VL/other red-flag results

Strategy

Immediate recall of client by clinical services supervisor at facility- contacts client and group leader informed of recall who then conducts home visit

Minimum period for action/action failure risk

Immediately after result received at facility/high risk

Maximum period for action/action failure risk

2-3 months/medium risk

Clinical outreach from facility potential

By whom

Yes. Clinical outreach is provided by mobile team to CDDP (not to the CCLAD venue)

ART refill preparation

Is ART pre-packed?

Yes (for entire group)

ART refill collection date

Group leader given scheduled appointment return date at CDDP for group

ART refill provision to group meeting location

How

Group leader goes to CDDP to collect ART refill for all group members and distributes upon return at group meeting venue in community

By

Group leader

Referral criteria (to facility)

Criteria

Group leader ascertains non-adherence or client complaining of being unwell/reporting symptoms/pre-determined red flags (including pregnant/screened positive for TB)

By

Client/group leader

To

Facility/CDDP mobile outreach

When

Any time/ART refill visit at CDDP

Client records

Facility clinical folder

Brought from facility with mobile outreach team to CDDP and completed only at clinical consultations

Client ART card

Brought to every ART refill visit and updated with return date

Monitoring system

At group meeting venue

ART refill form managed by group leader

At health care facility

Client visits captured from ART refill form into TASO electronic monitoring system

Resources