Community-supported models of care for
people on HIV treatment in sub-Saharan Africa
M. Bemelmans, S. Baert,
E. Goemaere, L. Wilkinson,
M. Vandendyck, G. Van
Cutsem, C. Silva,
S. Perry, E Szumilin,
R. Gerstenhaber, L. Kalenga,
M. Biot, N. Ford
MSF OCB
Scientific day 2014
STABLE patient
on ART
Monthly clinic
visit for
consultation
and ART refill
How to deal
with a growing
cohort of
stable patients
on ART?
Peter
PeterCasaer
Casaer
Community-supported models of care
DR Congo
Malawi
Mozambique
South Africa
Project
Chiradzulu,
Malawi
Khayelitsha,
South Africa
Kinshasa,
DR Congo
Tete,
Mozambique
Context
Rural
Urban
Urban
Rural
ART refill
3-monthly
2-monthly
3-monthly
Monthly
Group
Individual
Group
Where Health facility
Health facility
or community
venues
Community
distribution
points
Patients’ homes
Led by Lay worker
Lay worker
Lay worker of
network of
PLHIV
Self-formed
group of
patients
Mode Individual
Clinical
consultation
6-monthly
Yearly
Yearly
6-monthly
Blood drawing
Yearly viral load
Yearly viral load
Yearly CD4
6-monthly CD4
Project
Chiradzulu,
Malawi
Khayelitsha,
South Africa
Kinshasa,
DR Congo
Tete,
Mozambique
Context
Rural
Urban
Urban
Rural
ART refill
3-monthly
2-monthly
3-monthly
Monthly
Group
Individual
Group
Where Health facility
Health facility
or community
venues
Community
distribution
points
Patients’ homes
Led by Lay worker
Lay worker
Lay worker of
network of
PLHIV
Self-formed
group of
patients
Mode Individual
Clinical
consultation
6-monthly
Yearly
Yearly
6-monthly
Blood drawing
Yearly viral load
Yearly viral load
Yearly CD4
6-monthly CD4
Project
Chiradzulu,
Malawi
Khayelitsha,
South Africa
Kinshasa,
DR Congo
Tete,
Mozambique
Context
Rural
Urban
Urban
Rural
ART refill
3-monthly
2-monthly
3-monthly
Monthly
Group
Individual
Group
Where Health facility
Health facility
or community
venues
Community
distribution
points
Patients’ homes
Led by Lay worker
Lay worker
Lay worker of
network of
PLHIV
Self-formed
group of
patients
Mode Individual
Clinical
consultation
6-monthly
Yearly
Yearly
6-monthly
Blood drawing
Yearly viral load
Yearly viral load
Yearly CD4
6-monthly CD4
Project
Chiradzulu,
Malawi
Khayelitsha,
South Africa
Kinshasa,
DR Congo
Tete,
Mozambique
Context
Rural
Urban
Urban
Rural
ART refill
3-monthly
2-monthly
3-monthly
Monthly
Group
Individual
Group
Where Health facility
Health facility
or community
venues
Community
distribution
points
Patients’ homes
Led by Lay worker
Lay worker
Lay worker of
network of
PLHIV
Patients
Mode Individual
Clinical
consultation
6-monthly
Yearly
Yearly
6-monthly
Blood drawing
Yearly viral load
Yearly viral load
Yearly CD4
6-monthly CD4
What are the benefits
for patients and health
systems
across these communitysupported models?
Methods
• Assessing 4 approaches to
manage stable patients on
ART
• From a patient and health
system perspective
• Reviewing routinely collected
programme data as well as
published studies
Results
“The advantage of being in a
CAG is that you can do other
small jobs when you know that
a group member will collect
ART for you. This makes
things easier “
CAG Group member, Tete, Mozambique
Rasschaert, 2014
Transportation costs
3x less at PODI versus hospital
Time spent for ART collection
14 minutes at PODI
versus
85 minutes at hospital
Jocquet, 2011
69% reduction in ART
refill visits
Billaud, 2014
Improve
health
outcomes
Project data, Chiradzulu, 2013
Luque-Fernandez, 2013
Kalenga, 2013
Preliminary data, Tete, 2014
High retention in care
Improve
health
outcomes
Eligible & joined
Eligible & did not join
Project data, Chiradzulu, 2013
Luque-Fernandez, 2013
Kalenga, 2013
Preliminary data, Tete, 2014
Better retention than in
conventional care
“… belonging to a group
strengthens people. Moreover,
being united people become
mentally stronger during
treatment compared to those
who do it individually.”
CAG leader, Tete, Mozambique
Rasschaert, 2014
Cost per patient per year
Adherence club
58 US$
Lower
Service
Provider
Costs
Conventional care 109 US$
Samantha Reinders
Bango, 2013
Strong publication and
dissemination efforts
Major impact on national &
international policy
What is MSF’s
responsability
in national
roll-outs?
Critical enablers
Brendan Bannon
André Francois
Recognition of lay Realistic
workers
Acces to quality clinical management
planning
Flexible adaptations
Brendan Bannon
Reliable monitoring system
Miguel Cuenca
Robust drug supply
Conclusion
• Community supported models respond to the
needs of a growing cohort of stable patients on
ART and their health care workers
• Adaptation of these models is ongoing to include
other HIV+ patients and allow for a wider
application to other diseases
• Further analysis and advocacy is needed to
ensure models are adapted to contexts and critical
enablers are in place
André Francois
Acknowledgements
• Patients living with
HIV in subSaharan Africa
• MSF and Ministry
of Health staff in
our projects in
sub-Saharan
Africa
• Co-authors
André Francois
Extra’s
Project
Chiradzulu,
Malawi
Khayelitsha,
South Africa
Kinshasa,
DR Congo
Tete,
Mozambique
Start
2008
2007
2010
2008
Nr patients
joined
8566
5900
2162
8181
% active ART
cohort
20%
23%
43%
50%
samumsf.org
Improve testing & linkage to care
3168 tested for HIV
8,6% HIV +
40% joined CAG
42% eligible for ART
89% eligible and started ART
Project data Changara, 2013