Experiences and Perceptions on Community Client-Led ART Delivery (CCLADS) Model of Antiretroviral (ART) Delivery: Patients’ and Providers’ Perspectives in South Western Uganda

Abstract

Purpose Community Client-Led ART Delivery groups (CCLADS) were introduced as part of the differentiated service delivery models in 2017 to better serve growing number of HIV patients and reduce unnecessary burden on the HIV care delivery system. However, there is limited evidence on the exact patients’ and care providers’ experiences and perceptions regarding the CCLADS model of ART delivery. We therefore aimed to explore the experiences and perceptions on CCLADS model from the patient and provider perspectives. Participants and Methods A descriptive qualitative study was conducted at two ART clinics in Southwestern Uganda. We conducted in-depth interviews (IDI) to get a deeper understanding of the patient and providers’ perspective regarding the model. Responses from participants were recorded using audio recorders and were translated and transcribed. We used thematic approach to analyze the data. Results A total of 20 in depth interviews were conducted, with providers, CCLAD leaders and Adults Living with HIV (ALHIV) to assess the experiences and perceptions to participation among People Living with HIV (PLHIV) enrolled in CCLADS and the care providers. Key themes included benefits, limitations, experiences and perceptions of CCLADS. Benefits to ALHIV included: Longer refills, reduced transport costs, receive drugs in time, peer advice; to providers: time saving, less tiresome and reduced congestion at facility. Barriers included: stigma, limited outreaches, failure to comply. Patients perceived the model positively (cost effective, improved quality care, no missed appointment where as others were negative (blood samples not taken like before). Experiences also included enough time, learnt some activities and good adherence. Conclusion Participation in the CCLADS groups provides several benefits to the patient including reduced transport, longer refills and good adherence. Stigma remains a challenge to CCLADS participation, which requires innovative and collaborative strategies from Ministry of Health (MOH) and implementation partners to address in order to sustain CCLADS participation.

Factors associated with ART interruption during the COVID-19 crisis in Burundi (the EPIC community-based research program)

“…However, our multivariable analysis did not highlight any significant difference between PLHIV who received ART from peer CHW and those who received it directly at the clinic. This result contrasts with findings in certain other contexts where community-based delivery was associated with better treatment adherence 16 , 35 , 37 , 38 whether in times of crises or not 39 , 40 . This discrepancy may be explained by a fear of being recognized – and therefore stigmatized—as a PLHIV by persons in the general community if one were to go to an ART delivery point, something which has been observed in other contexts (e.g.…”

“…This discrepancy may be explained by a fear of being recognized – and therefore stigmatized—as a PLHIV by persons in the general community if one were to go to an ART delivery point, something which has been observed in other contexts (e.g. Uganda) 16 , 38 , 41 , 42 .…”

Barriers to enrolment of clients into community client led anti-retroviral therapy delivery (CCLAD) in selected health facilities in Kasese District, Uganda

“…The findings are supported by Long et al 22 who pointed that peer-led ART delivery models are most likely to fail in communities where there exist other organizations with different motives. This is similar to documented experiences and perceptions on CCLADS Model from Patients' and Providers' Perspectives in South Western Uganda 23 . Many other scholars found similar results related to discrimination 20 .…”

Factors Influencing ART Adherence Among Persons Living with HIV Enrolled in Community Client-Led Art Delivery Groups in Lira District, Uganda: A Qualitative Study

“…Similar studies have shown that adherence rates were higher in groups where clients were involved in the distribution and administration of ART drugs than in those where healthcare providers were responsible for the entire process. 8 , 15 , 16 …”

“…This is due to the fact that transport costs can be a significant barrier to accessing healthcare services in many low-income countries. 8 Especially in rural and remote areas, clients may have to travel long distances to reach health facilities, which can be expensive. Our results are in agreement with evidence from elsewhere, where patients participating in the CCLAD model valued the opportunity to share the burden of ART refill pick-up transportation costs from facilities.…”