Thousands living with HIV embrace community HIV treatment re-fill groups

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By Staff Reporter

PEOPLE living with HIV have positively welcomed the Community Antiretroviral Treatment Re-fill Groups (CARGS) programme in which people from the same area take turns to travel to the local clinic to pick up HIV treatment for the rest of the members of their group.

A recent study published by the Journal of the International AIDS Society (JIAS) said the innovative project, mostly adopted in rural and farming communities, where clinics are fewer and longer distances away, was a welcome initiative for thousands of people living with HIV as they spend less money on transportation.

Local health community workers said the programme freed up more time for in-need patients and also reduced their overall workload.

“The CARGs model is one such initiative designed to help time-poor clients, as well as those living in rural areas far away from treatment dispensaries,” the JIAS noted in its August report.

The Ministry of Health and Child Care has five antiretroviral treatment (ART) refill options included in their guidelines: fast‐track (patients collect ART from the pharmacy without a clinical exam), club refill (facility‐based HCW‐led group refills), outreach (individual ART delivery through mobile outreach), family member refill (one individual collects ART for all family members) and CARGs.

The government started national roll-out of CARGs in late 2016, following the success of Mozambique’s CARG programme.

“In Zimbabwe, stable ART clients from the same geographic location are encouraged to self-form into groups of anywhere between four and 12 members, and elect a person every three months to collect treatment for the group.

“The group will then normally travel to the clinic together for their annual health and viral load check. Before each ART pick-up they will also screen each other for tuberculosis or any other opportunistic infections and are encouraged to visit the clinic if they feel unwell,” the JIAS report says.

According to data from 19 districts, there were 35,810 active CARG members, representing 9% of ART clients in these districts.

ART clients said they were satisfied with the CARG model, saying that it helped to improve their ART adherence by removing the challenge of travelling to the clinic.

“We actually remind each other when to take our drugs…if you are part of a WhatsApp group and you see a message reminding people to take their drugs you are prompted to take them on time,” said one ART client.

CARG members also largely felt confident enough within their groups to ask questions, and said it was an opportunity to share knowledge and information on HIV and health workers at clinics were more professional with less waiting time.

In the survey, 97% of health workers reported that implementing CARGs had reduced their workload.

“It’s now easy for us since we no longer have a lot of people coming to the facility at the same time like we used to have in the past. In the afternoon, we can actually concentrate on other tasks that we failed to do in the past because of a large number of clients coming in,” one health worker said.

Health workers also noted that the number of clients who defaulted on ART had declined since the inception of the CARG model, which meant that fewer clients needed to be tracked.

“On top of this, communicating with clients was much easier through the groups, because they only needed to relay the message to the next person coming in for pick-up.”

An estimated 1, 3 million people are living with HIV in Zimbabwe and 88% are on treatment.