Background As antiretroviral treatment continues to expand, ensuring patient retention over time is an increasingly important concern. This, together with capacity and human resource constraints, has led to the consideration of community drug distribution point (CDDP) model for the delivery of antiretroviral therapy (ART). In 2008, TASO Rukungiri launched a community model of ART distribution and adherence monitoring by community groups in Rukungiri district.
Description Patients who are stable on ART for 3 months are informed about the community ART group model and invited to join the groups. Group members have 4 key functions: facilitate monthly ART distribution to other group members in the community, provide adherence and social support, monitor outcomes, and ensure each group member undergoes a clinical consultation at least once every 6 months. Group members visit the centre on a rotational basis, such that each group member has contact with the service centre every 6 months. Drugs are given on two monthly bases. At every six month visit at the service centre every client is done the following tests: CD4 count, h b levels, viral load, Lfts and Rfts.
Results Between February 2009 and May 2011, 3000 members were enrolled into 69 groups. Median follow-up time within a group was 12.9 months (IQR 8.5–14.1). During this time, 180 (6%) were transferred out, 2820 patients still in community groups, 2749 (97.5%) were remaining in care, 56 (2%) had died, and 6 (0.2%) were lost to follow-up.
Lessons learnt: Decongestion at the service centre, easy access, monitoring, adherence and quality service, finally proper documentation.
Conclusion The Community ART Group model was initiated by TASO to improve access, patient retention, and decongest centre services. Early outcomes are highly satisfactory in terms of mortality and retention in care, lending support to such out-of-clinic approaches.