Health care worker-managed group

Clinical
Specific populations
Context

"In clubs, we can really talk to each other, share stories, discuss stigma, find solutions and learn from each other"

Client, South Africa

Health care workers are responsible for the management of the provision of ART drug supply, care and support to groups of stable clients. 25-30 stable clients meet for 30-60 minutes and are facilitated by a lay health care worker who provides a brief symptom screen, referral where necessary, peer support and distribution of pre-packed ART to all the members present every 2-3 months (4-6 times a year). No client folders are pulled; nor is individual adherence counselling provided. Group members have their viral load taken at one of their annual group visits and are seen individually for clinical review at their next group visit. They also have access to clinicians through the model referral mechanisms if they become unwell. Group members are allowed to send a friend or family member to collect their ART drug supply in the group. Group attendance is recorded as a client visit in the paper-based registers, which are then captured in the facility’s electronic monitoring system (EMR).

Who is eligible for this model?

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 (>18 years)

ART refills

WHAT

ART refill
Group adherence support
Brief symptom screen
Weighed
Psychosocial support
Referral if unwell
Laboratory tests (ART refill visit prior to clinical consultation)

WHEN

2 monthly
3 monthly

WHERE

Primary care clinic
Community venue

WHO

Lay health care worker

Clinical consultation

WHAT

ART rescripting
Clinical monitoring
ART refill

WHEN

Annual

WHERE

Primary care clinic

WHO

Nurse
Physician

Summary of the model (per year)

Summary of evidence

A number of peer-reviewed journal articles from the implementation and outcomes of adherence clubs in the Western Cape province of South Africa have been published (1,3,4,8). To date, more than 100,000 clients in South Africa are receiving their ART treatment, care and support within a health care worker-managed group. Clients receiving care in this model have improved retention and viral suppression compared with clients in the facility-based standard of care (3, 4).

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. 

Swaziland clubs
Swaziland
Facility-based healthcare worker-led club refill
Zimbabwe
Healthcare worker-led community ART groups
Kenya
Cape Town Metro, Western Cape, South Africa
Cape Town Metro, Western Cape, South Africa
Khayelitsha, Western Cape, South Africa
Zambia clubs
Lusaka, Zambia
Western Cape province, South Africa
Teen Clubs
Malawi
Khayelitsha, South Africa

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