The rollout of Community ART Refill Groups in Zimbabwe: a qualitative evaluation.
HIV
ART delivery
Zimbabwe
community-based
differentiated care
differentiated service delivery
Journal
Journal of the International AIDS Society
ISSN: 1758-2652
Titre abrégé: J Int AIDS Soc
Pays: Switzerland
ID NLM: 101478566
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
21
01
2019
accepted:
09
08
2019
entrez:
28
8
2019
pubmed:
28
8
2019
medline:
29
4
2020
Statut:
ppublish
Résumé
Community ART Refill Groups (CARGs) are an antiretroviral therapy (ART) delivery model where clients voluntarily form into groups, and a group member visits the clinic to collect ART for all group members. In late 2016, Zimbabwe began a nationwide rollout of the CARG model. We conducted a qualitative evaluation to assess the perceived effects of this new national service delivery model. In March-June 2018, we visited ten clinics implementing the CARG model across five provinces of Zimbabwe and conducted a focus group discussion with healthcare workers and in-depth interviews with three ART clients per clinic. Clinics had implemented the CARG model for approximately one year. All discussions were audio recorded, transcribed, and translated into English, and thematic coding was performed by two independent analysts. In focus groups, healthcare workers described that CARGs made ART distribution faster and facilitated client tracking in the community. They explained that their reduced workload allowed them to provide better care to those clients who did visit the clinic, and they felt that the CARG model should be sustained in the future. CARG members reported that by decreasing the frequency of clinic visits, CARGs saved them time and money, reducing previous barriers to collecting ART and improving adherence. CARG members also valued the emotional and informational support that they received from other members of their CARG, further improving adherence. Multiple healthcare workers did express concern that CARG members with diseases that begin with minor symptoms, such as tuberculosis, may not seek treatment at the clinic until the disease has progressed. We found that healthcare workers and clients overwhelmingly perceive CARGs as beneficial. This evaluation demonstrates that the CARG model can be successfully implemented on a national scale. These early results suggest that CARGs may be able to simultaneously improve clinical outcomes and reduce the workload of healthcare workers distributing ART.
Identifiants
pubmed: 31454178
doi: 10.1002/jia2.25393
pmc: PMC6711352
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Evaluation Study
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25393Subventions
Organisme : FIC NIH HHS
ID : D43 TW009539
Pays : United States
Organisme : PEPFAR
Pays : United States
Informations de copyright
© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
Références
J Int AIDS Soc. 2017 Mar 28;20(1):21374
pubmed: 28406273
BMC Public Health. 2014 Apr 15;14:364
pubmed: 24735550
J Acquir Immune Defic Syndr. 2011 Feb 1;56(2):e39-44
pubmed: 21084990
PLoS One. 2016 Dec 1;11(12):e0166444
pubmed: 27907084
J Int AIDS Soc. 2019 Aug;22(8):e25393
pubmed: 31454178
J Int AIDS Soc. 2018 Mar;21(3):
pubmed: 29537628
BMJ Open. 2017 Aug 11;7(8):e016800
pubmed: 28801427
J Acquir Immune Defic Syndr. 2016 Oct 1;73(2):e11-22
pubmed: 27454248
J Int AIDS Soc. 2016 Dec 01;19(1):21484
pubmed: 27914186
J Int AIDS Soc. 2017 Jul 21;20(Suppl 4):21650
pubmed: 28770594
J Int AIDS Soc. 2014 Oct 06;17:18910
pubmed: 25292158
PLoS One. 2014 Mar 20;9(3):e91544
pubmed: 24651523
Trop Med Int Health. 2014 May;19(5):514-21
pubmed: 24898272
AIDS Res Treat. 2014;2014:137545
pubmed: 25548659