Scaling up community ART groups in Mozambique

Aims: To describe the stepwise implementation and roll out of Community ART Groups (CAG) in Mozambique.

Study Design: Descriptive study

Place and Duration of Study: Mozambique, between February 2008 and December 2011.

Methodology: Description of the stepwise implementation of a model for Anti-Retroviral Therapy (ART) delivery based on the principles of peer support and self-management. The program data on CAG were obtained through a chart review and routine data-collection.

Results: To overcome patient reported barriers to monthly drug refills for ART the Tete Provincial Directorate of Health and Médecins Sans Frontières developed a community-based ART model or patient-centered model, through peer support groups named CAG. The first CAG commenced in 2008, in rural health facility catchment areas, where members of CAG shared transport costs to overcome distances to the ART clinics. In 2009, lessons learnt were exported in Tete province and CAG model was launched in semi-urban contexts to decrease time spent in the clinics. In 2011, retention rates as high as 97,5 % convinced a joint task force that included Ministry of Health and major partners to pilot the CAG strategy on a national scale.

Conclusion: To respond to staggering attrition rates Ministry of Health in Mozambique and partners piloted an innovative patient-centered model for HIV care and exported good practices from local to provincial and national level. Success of scale up will depend on the collaboration and interaction between policymakers, donors, health-managers, caregivers, communities, and patients.

Keywords: HIV, antiretroviral therapy, highly active, task shifting, health services accessibility, patient participation, peer group