Health care worker-managed groups

Family clubs

Clinical
Specific populations
Context

Family clubs have been implemented at two clinics in the Khayelitsha area of Cape Town by MSF in partnership with local health authorities.. Family clubs are comprised of 15 children stable on ART and their caregivers. Clubs are led by a lay health care worker and meet five times per year. Family clubs are grouped by age bands of children (4-7 years, 7-10 years, 10-15 years) and disclosure status (not disclosed, partially disclosed and fully disclosed). In this model, both the children and their caregivers (if HIV positive and stable on ART) receive their pre-packed ART in the group (caregiver’s ART pre-packed before club visit and children’s ART packed during group support session). The annual viral loads and clinician reviews are aligned with group ART refill collection (children are <5 years viral load and clinical review bi-annually). The lay health care worker provides support to caregivers for phased child disclosure and peer support.

Who is eligible for this model?

Children aged 4-15 years: Same ART regimen for 12 months, 1st or 2nd line ART, 2 consecutive undetectable VLs, no active TB, no condition requiring regular clinical follow up
Adult caregivers >18 years: 6+ months on ART, 1st or 2nd line ART, 1 undetectable VL, no active TB, no condition requiring regular clinical follow up

ART refills

WHAT

ART refill
Group adherence support
Brief symptom screen
Weighed and dosage adjusted for children
Child disclosure support

Referral if unwell
Laboratory tests (VL taken at/after ART refill visit)

WHEN

5/year
(receive a 4-month refill over year end)

WHERE

Primary care clinic

WHO

Lay health care worker

Clinical consultation

WHAT

If child: ART dosage adjusted on script for any weight gain
ART rescripting
Clinical monitoring
ART refill

WHEN

Annual
(Twice if child <5 years)

WHERE

Primary care clinic

WHO

Nurse
Physician

Summary of the model (per year)

*children <5 years have two viral loads taken every year and two clinical consults

Location

Family clubs
Cape Town Metro, Western Cape, South Africa

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