Out-of-facility individual

Clinical
Specific populations
Context

"My clinic is so far. I cannot go there every month."

Client, Malawi

In these models, 1-3 months ART refills are distributed to stable clients outside of the health facility environment. ART refills are provided to clients either directly at their home by community health workers or collected by the client from a community pharmacy or at specific community locations operated either by community health workers or through a mobile outreach service operated from the facility or sub-district health service. ART refills are usually separated from clinical follow up, which takes place 1-2 times annually at the facility.

Who is eligible for this model?

On ART for 12 months, 1st or 2nd line ART, undetectable VL or no current evidence of immunological or clinical failure, no active TB, no condition requiring regular clinical follow-up, adult (>18 years)

ART refills

WHAT

ART refill
Adherence support
Referral if unwell

WHEN

Monthly
Bi-monthly
3 months

WHERE

Community venue
Home

WHO

Lay health care worker
Peer/volunteer
Courier service

Clinical consultation

WHAT

Laboratory tests
ART rescripting
Clinical monitoring
ART refill

WHEN

6 months
12 months

WHERE

Primary care clinic
Community venue

WHO

Nurse

Summary of the model (per year)

Summary of evidence

Peer-reviewed journal articles from the implementation and outcomes of fixed community distribution point models have been published (1,2,3) showing good or improved retention outcomes to facility-based standard of care. Two cluster randomized controlled trials (RCTs) look at home delivery implemented in Uganda and Kenya compared with facility-based care. Both showed no significant differences in outcomes reported (6,7).

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. 

Fixed community ART distribution points

South Africa CCMDD (Central Chronic Medicine Dispensing and Distribution)
South Africa
Community ART distribution points
Kenya
PODIs (Community ART distribution points) houses, DRC
Lubumbashi, Democratic Republic of the Congo
Kinshasa, Democratic Republic of the Congo

Mobile outreach

Swaziland mobile ART refill delivery
Swaziland
Mobile outreach ART refill
Zimbabwe
Uganda Kitovu mobile
Masaka, Uganda
Musina farm mobile ART services
Musina, Limpopo, South Africa

Home delivery

Individual patient ART distribution in community
Kenya
TASO home delivery
Jinja, Uganda
Bicycle courier
Khayelitsha, Western Cape, South Africa
AMPATH home delivery
Mosoriot, Kenya

Need more details?

More information on how to implement this model. 

More details