CARGs promoting adherence in communities

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By Vivian Mugarisi

The introduction of the community ART refill groups (CARGs) in rural areas has brought relief most people living with HIV had been looking for, for many years.
Under the model, villagers take turns to go and collect their anti-retroviral drugs on behalf of those in their group. This means that the out-of-pocket payments patients encounter in trying to access treatment are reduced, minimising the chances of one defaulting on treatment.  
CARGs focal person for Venice and Donain areas in Mhondoro-Ngezi district Mrs Theresa Phiri hailed the programme saying it has brought the much needed respite in the community.
She said the groups serve as a cost cutting measure apart from increasing adherence as shown by the growing number of people showing interest.   
“We started with 10 groups which are supported by the Global Fund and we are growing now we have six more groups, making them 16.
“Each person needs a minimum of $2 to and from Donain Clinic to get their 3 months’ supply of ARVs so these groups have helped us cut traveling costs as only one person can collect drugs for everyone in our group,” said Mrs Phiri.
“Some people were shying away from talking about their status, and most were defaulting because they thought they were the only one who were HIV positive but the formation of the community art refill groups have helped most of the people living with HIV talk about their stories and share with those who are living positively as well.
She said this has helped health care providers to save time as they now have to serve one person instead of 10 or 12. Mrs Phiri also added that male involvement has been very low.
“We still have a challenge with men however. Most of them do not want to be involved in such set-ups and it’s even worse for the artisanal miners as they move from one mine to another and most of the times stop taking their medications regularly,” she said.
The CARG model was introduced in 2012 as a pilot project in Gutu by the Medecins Sans Frontiers (MSF). National AIDS Council with funding from the Global Fund then adopted the concept and rolled it out in 2015.
The major aim of the model is to reduce the burden and challenges for both health care workers and patients in the provision and receipt of ART and improving adherence and members are usually from the same geographical area.
Acting Sister-in-charge at Donain Clinic, Vimbayi Kasiyano said those in art refill groups have helped managing and follow-up of patients easier.  
“The groups have helped us manage the flows at the clinics as we are now serving less people than we used to.
“They also have an attendance register where the leader monitor progress, who has taken their medication and those who have not, making follow up very easy,” said Sr Kasiyano.
 
She however said those pregnant and those who have been on ART for less than 6 months are not allowed to be in the group as they require regular monitoring and refill.
NAC Meaningful Involvement of People Living with HIV Coordinator Mr Silibele Mpofu said the groups have assisted in improving adherence in rural communities. He said the cost cutting component that characterises CARGs has made it easy
“There are some areas where our clients have to travel long distances and sometimes fork out as much as $10 to get their supply of drugs so CARGs make it easier as it is cost effective,” he said.
He added, “Before they also go for refill, they do pill counting too see if all members are adhering and if one is defaulting, it becomes easier for health care workers to give them necessary support.
“It also reduces congestion at health facilities and help reduce loss to follow up as it becomes easier to track those defaulting.”
According to the National AIDS Council, at least 12 percent of people living with HIV are defaulting every year, and an average of 16, 2 percent every two years.


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