Mozambique’s Community Antiretroviral Therapy Support Group Program: The Role of Social Relationships in Facilitating HIV/AIDS Treatment Retention

Kun, Karen E.; Couto, Aleny; Jobarteh, Kebba; Zulliger, Rose; Pedro, E; Malimane, Inácio; Auld, Andrew F.; Meldonian, Marisa

doi:10.1007/s10461-019-02419-6

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…This finding corroborates findings in Ethiopia, Mozambique, and Zimbabwe where non-formal groups were a key source of financial, nutritional, and psychosocial support among many others. 67,68,[71][72][73][74] However, fewer participants of this study thought that bridging and bonding networks had a role in overcoming health system-related barriers. This was partly because of the inability to disclose health system-related barriers to their networks, second to a perception that they would do nothing to change them.…”

Section: Perceived Roles Of Social Networkmentioning

confidence: 84%

Social Networks and Barriers to ART Adherence Among Young Adults (18–24 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study

Ajuna¹,

Tumusiime²,

Amanya³

et al. 2021

HIV

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Background: Young adults living with HIV (YALWH) struggle to maintain high levels of adherence to antiretroviral therapy (ART) because of numerous barriers. This study describes the social networks of YALWH (18-24 years), their barriers to ART adherence, and the perceived role of social networks in overcoming those barriers. Methods: This study used a qualitative descriptive research design. Twenty-three (23) YALWH who were on ART for a period of greater than one (1) month and had consented to participate in the study were purposively selected from two primary health care facilities in southwestern Uganda. We held four (4) focus group discussions with the YALWH over 5 weeks between the 24th of July and 7th September 2020. Data were audio recorded, transcribed, and entered in Microsoft word 2010. Using the content analysis techniques, data were inductively coded and categories or themes developed. Results: Most YALWH belonged to bonding (family, friends, and neighbors), followed by bridging (informal groups), and linking (health professionals) social networks, respectively. Most YALWH, irrespective of gender, had close connections with their mothers or elder sisters. The commonest form of bridging networks was informal community groups that provided financial services, whereas the linking ones comprised health professionals' directly involved in HIV patient care such as nurses, counselors, and their affiliates (expert clients or clinic based peer supporters), who occasionally acted as bonding networks. Structural barriers to ART adherence (eg, stigma) were the most cited, followed by medication-(eg, pill burden), and patient-related barriers (eg, non-disclosure of HIV status). Bonding networks were perceived to help overcome patient, medication, and structural barriers to ART adherence. Bridging networks overcame structural and medication-related barriers to ART adherence. Linking networks were perceived to help overcome some health systems and medication-related barriers to ART adherence. Conclusion: Bonding social networks seem to play a prominent role in overcoming numerous barriers to ART adherence compared with bridging and linking social networks.

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Section: Perceived Roles Of Social Networkmentioning

confidence: 84%

Social Networks and Barriers to ART Adherence Among Young Adults (18–24 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study

Ajuna¹,

Tumusiime²,

Amanya³

et al. 2021

HIV

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“…A study comparing clinic versus community-based ART clubs in Johannesburg, South Africa found that in the ART clubs, patients felt a new ‘openness’ or ‘freedom’ to discuss HIV-related issues and the groups led to peer support and friendships that empowered individuals to accept their HIV status and take their ARTs [ 16 ]. Another study that also explored community-based ART groups, found that social and peer support significantly improved individuals’ ability to remain motivated to continue their ARTs and visit each other when ill [ 17 ]. Overall, community-based interventions have been shown to increase HIV awareness and risk-reduction [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Taking care to the patients: a qualitative evaluation of a community-based ART care program in northern Namibia

Katirayi

Shoopala

Mitruka

et al. 2022

BMC Health Serv Res

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Background Namibia is a large sparsely populated country with a high prevalence of HIV. People living with HIV who reside in remote areas often travel long distances through tough desert terrain to access HIV care and treatment. To address this barrier, community-based antiretroviral therapy (C-BART) sites were established in Okongo (2007–2008) and Eenhana districts (2016) of northern Namibia with the goal of bringing HIV and other health services closer patients’ homes. We conducted a qualitative evaluation of the acceptability and challenges of C-BART to guide program improvement. Methods For this qualitative descriptive study, research assistants collected data (August-December 2017) through in-depth interviews with 40 patients, seven health extension workers, and 11 policy/program managers, and through four focus group discussions with healthcare workers. Interviews were audio-recorded, translated, and coded using MAXQDA v.12. Data were analyzed using thematic analysis. Results The evaluation identified five themes: community ownership, acceptance of the C-BART sites, benefits of the C-BART program for the PLHIV community and their social networks, benefits of the C-BART program to the main health facility, and challenges with the C-BART program. The C-BART program was reported as life-changing by many patients who had previously struggled to afford four-wheel drive vehicles to access care. Patients and healthcare workers perceived that the community as a whole benefited from the C-BART sites not only due to the financial pressure lifted from friends and family members previously asked to help cover expensive transportation, but also due to the perception of diminished stigmatization of people living with HIV and improved health. The C-BART sites became a source of community and social support for those accessing the sites. Healthcare workers reported greater job satisfaction and decongestion of health facilities. The challenges that they reported included delays in authorization of vehicles for transportation to C-BART sites and lack of incentives to provide services in the community. Conclusion The C-BART program can serve as a model of care to expand access to HIV care and treatment and other health services to populations in remote settings, including rural and difficult-to-reach regions. The needs of healthcare workers should also be considered for the optimal delivery of such a model.

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“…These interventions increased ART coverage, especially in the high burden district to surpass the second and third UNAIDS “90” population target. These interventions involved a multidisciplinary approach including health workers and the community and capitalize on the importance of social relationships in HIV care 25,27 . Lastly, the use of point‐of‐care testing for early infant diagnosis has the potential to significantly increase ART initiation and coverage among children in Mozambique 28…”

Section: Methodsmentioning

confidence: 99%

“…ART coverage in Mozambique has experienced a steady upward progression with about a 62% increment from 2015 to 2020 (42% and 68%, respectively) 9 . In a bid to reduce the incidence of loss to follow‐up, the Mozambican Ministry of Health rolled out a national strategy called community adherence and support groups (CASG) to increase ART coverage 24,25 . This strategy allows an individual undergoing HIV treatment to get ARV drug for about five others in the same community monthly.…”

Section: Methodsmentioning

confidence: 99%

“…9 In a bid to reduce the incidence of loss to follow-up, the Mozambican Ministry of Health rolled out a national strategy called community adherence and support groups (CASG) to increase ART coverage. 24,25 This strategy allows an individual undergoing HIV treatment to get ARV drug for about five others in the same community monthly. According to a retrospective study conducted, it was found that the loss to follow-up of nonparticipants of the CASG was significantly higher than that of CASG participants (p = 0.04).…”

Section: Mozambiquementioning

confidence: 99%

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Review of antiretroviral therapy coverage in 10 highest burden HIV countries in Africa: 2015–2020

Babatunde

Akin‐Ajani

Abdullateef

et al. 2022

Journal of Medical Virology

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Africa is responsible for two‐thirds of the global total of new HIV infections. South Africa, Nigeria, Mozambique, Uganda, Tanzania, Zambia, Zimbabwe, Kenya, Malawi, and Ethiopia were responsible for 80% of HIV cases in Africa in 2014 according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). This study assesses antiretroviral coverage strategies implemented by these countries after the initiation of the “Fast‐Track strategy to end the AIDS epidemic by 2030.” Data reported in this review were obtained from different e‐bibliographic including PubMed, Google Scholar, and Research Gate. Key terms were “Antiretroviral therapy,” “Antiretroviral treatment,” “HIV treatment,” “HIV medication,” “HIV/AIDS therapy,” “HIV/AIDS treatment” + each of the countries listed earlier. We also extracted data on antiretroviral therapy (ART) coverage from the UNAIDS database. About 50 papers published from 2015 to 2021 met the inclusion criteria. All 10 countries have experienced an increase in ART coverage from 2015 to 2020 with an average of 47.6% increment. Nigeria recorded the highest increase in the rate of ART coverage (72% increase) while Ethiopia had the least (30%). New strategies adopted to increase ART coverage and retention in most countries were community‐based models and the use of mobile health technology rather than clinic‐based. These strategies focus on promoting task shifting, door‐to‐door access to HIV services, and a long‐term supply of antiretroviral medications. Most of these strategies are still in the piloting stage. However, some new strategies and frameworks have been adopted nationwide in countries like Mozambique, Tanzania, Zambia, Zimbabwe, Kenya, and Malawi. Identified challenges include lack of funding, inadequate testing and surveillance services, poor digital penetration, and cultural/religious beliefs. The adoption of community‐based and digital health strategies could have contributed to increased ART coverage and retention. African countries should facilitate nationwide scaling of ART coverage strategies to attain the 95–95–95 goal by 2030.

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Mozambique’s Community Antiretroviral Therapy Support Group Program: The Role of Social Relationships in Facilitating HIV/AIDS Treatment Retention

Cited by 10 publications

References 24 publications

Social Networks and Barriers to ART Adherence Among Young Adults (18–24 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study

Social Networks and Barriers to ART Adherence Among Young Adults (18–24 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study

Taking care to the patients: a qualitative evaluation of a community-based ART care program in northern Namibia

Review of antiretroviral therapy coverage in 10 highest burden HIV countries in Africa: 2015–2020

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