GAAC STRATEGY GRUPOS DE APOIO A ADESÃO COMUNITÁRIA COMMUNITY ADHERENCE SUPPORT GROUPS Rome, 17 th...
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Transcript of GAAC STRATEGY GRUPOS DE APOIO A ADESÃO COMUNITÁRIA COMMUNITY ADHERENCE SUPPORT GROUPS Rome, 17 th...
GAAC STRATEGY
GRUPOS DE APOIO A ADESÃO COMUNITÁRIA
COMMUNITY ADHERENCE SUPPORT GROUPS
Rome, 17th of July 2011
Ministry of Health, Mozambique
MSF-OCB, Mozambique
Mozambique
HIV Prevalence: 11,5% (INSIDA 2009)
30% Population without access to health (PES,2007)
1 in 5 HFs has ART (245 Total ART HFs)
Need for 7 X more HRH as compared to minimal WHO
recommendations ( 2010)
30 % ART coverage (WHO, end 2009)
~ 50 % LTFU ART at 3 years (CDC, not published)
Tete Province: April 2009, Partner initiative
Average time in GAAC: 13,2 months
3.530 members formed 788 GAACs
Strategy
GAAC (Community Adherence Support Groups) A model of community-based ART distribution and adherence monitoring by self-forming groups of patients on ART
Primary Objective
1. To improve retention in care of patients on ART through increasing patient involvement
Secondary Objectives
1. To improve access, retention and adherence of patients on ART.
2. To enhance the quality of the services and follow-up of patients at the HF.
3. To establish a system of early surveillance to triage medical conditions and situations related to LTFU.
4. To reduce the number of clinical appointments and the workload at the HF.
5. To reinforce the psychosocial support among ART and pre-ART patients.
6. To strengthen the link between the HF and the community.
Strategy
Home
January
Feb Mar Apr May Jun
GAAC in the community
Reception Consultation PharmacyLaboratoryCounselor
A B C D E
Health Facility
GAAC member 1 goes to HF every six months for clinical consultation, psychosocial counseling, lab tests and to pick up monthly GAAC ARVs
Member 1 returns to community and distributes ARVs to other 5 GAAC members 2
1
Member 1 goes home while members 2, 3, 4, 5 and 6 conduct GAAC trips to HF during the following five months
3
National Pilot: Methods
Pilot HF selection 3 Health Facilities in each province selected – 1 health facility from
each of three patient volume categories:
Each health facility required to provide a minimum package of services ART program for more than 6 months 2 staff (clinician, nurse) CD4 testing TB services
Patient Inclusion Criteria
On ART for at least 6 months, good adherence
Age ≥ 15 years OR children on adult ART
dosage
CD4 count ≥ 200 cel/ul and clinically stable
Interest in involvement in GAAC
National Pilot: Methods
Criteria for Group Formation
2- 6 members
Group is established according to social or cultural affinities related to
location, employment or other kind of relationship
Each group will be formed by members that selects a Focal Point
responsible for some of the main activities of the group
Group rotation
National Pilot: Methods
1. Tasks of GAAC Focal Point (within each group) Coordination with the HF
Monitor & report adherence to the treatment of each group member
Monthly meetings with his group (including one the day before going to the HF)
Defaulter tracing
Remind group members to go to the HF every 6 months
Refer patients whose condition requires medical attention
Stimulate the group to create a fund to support travel to the HF
National Pilot: Roles
2. Tasks of GAAC Members
Be representative of the group every 6 months for:
Pick up ARVs & distribute to rest of the group
Report adherence and health status of group members
Medical appointment every 6 months
Support group members for adherence to treatment
Refer patients whose condition requires medical attention
Home visits
Conduct educational sessions within community (HIV
prevention, stigma)
National Pilot: Roles
3. Tasks of GAAC Focal Point (nurse) at the HF Sensitize patients on GAAC Clinically assess for eligibility for GAAC Coordination with GAACs Train the focal points and members of the GAACs on HIV/AIDS, Ois, CD4, reporting and other aspects of the management group. Monthly follow up and monitoring the adherence on the GAAC Monitor and follow up patients with low CD4 counts, poor adherence, anemia and other aspects relating to ART. File management of GAACs Provide M&E, IEC materials to the focal point
National Pilot: Roles
Proposed M&E Tools
1. ARVs Control Register: To register monthly patient pill-counts and report warnings of potential OIs (filled out in the GAAC community)
2. GAAC Register Book: To register and follow up information about the group members (including basic demographic and treatment follow-up information)
3. GAAC Monthly Report: To track GAAC expansion and trends in GAAC patient retention at the HF, district, provincial and national level
National Pilot: M&E