Model mechanics

ART refills

Clinical consultations

Individual/group approach

Individual (30-60 per CDDP)

Individual

Who attends?

Client or community client-led ART delivery (CCLAD) group leader

Client

Client recruitment

Where

At facility and in community

By whom

Facility lay health care worker providing model education and promotion in facility waiting rooms
TASO expert patient volunteers educate patients from their community on model
Clinician and facility counsellor at eligibility assessment for model participation

Eligibility assessment

By clinician and facility counsellor during counselling session and clinical consultation

Group formation

By counsellor at facility

HIV disclosure

Does it happen?

Indirectly yes, as group of ART patients are given the same appointment date and time to meet at CDDP point

Annual health care visit schedule for client

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

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

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

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

(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, blood draw and clinical review all on same day  

Alignment of ART refill and clinic visits

Does it happen?

Yes. ART refill, blood draw and clinical review all on same day

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

Strategy

Immediate recall of client by clinical services supervisor at facility who contacts client and CDDP lay health care worker who conducts home visit

Minimum period for action/action failure risk

Immediately after result received at facility/medium risk

Maximum period for action/action failure risk

2-3 months/medium risk

Clinical outreach from facility potential

By whom

Yes. Health facility clinical staff attend CDDP location to provide blood draw and clinical review

ART refill preparation

Is ART pre-packed?

Not at facility; packed and distributed at CDDP by counsellor at community distribution point (also pre-packs at CDDP for CCLAD group leader collection)

ART refill provision to group meeting location

How

Box with ART transported to community distribution point

By

Facility counsellor

Clinical referral mechanism

Criteria

Lay health care worker ascertains non-adherence, client complaining of being unwell, client reporting symptoms, pre-determined red flags

By

Lay health care worker (at ART refill visits)
Counsellor/nurse (at clinical review)

To

Facility clinician

When

To attend facility as soon as possible

Up referral (return to standard of care)

Criteria

Client not adhering to treatment or clinically unstable requiring more frequent or intense clinical follow up, including:

  • Significant CD4 count drop
  • Presence of OIs
  • Pregnancy
  • Substance abuse
  • GBV and lack of family support system

(Clients are not up referred for missed visits but are followed at home by CDDP lay HCW and refilled at home)

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 community distribution point

Pharmacy list and ART refill form

At health care facility

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

Resources