The rollout of Community ART Refill Groups in Zimbabwe: a qualitative evaluation

Abstract

Introduction Community ART Refill Groups (CARGs) are an antiretroviral therapy (ART) delivery model where clients voluntarily form into groups, and a group member visits the clinic to collect ART for all group members. In late 2016, Zimbabwe began a nationwide rollout of the CARG model. We conducted a qualitative evaluation to assess the perceived effects of this new national service delivery model. Methods In March‐June 2018, we visited ten clinics implementing the CARG model across five provinces of Zimbabwe and conducted a focus group discussion with healthcare workers and in‐depth interviews with three ART clients per clinic. Clinics had implemented the CARG model for approximately one year. All discussions were audio recorded, transcribed, and translated into English, and thematic coding was performed by two independent analysts. Results In focus groups, healthcare workers described that CARGs made ART distribution faster and facilitated client tracking in the community. They explained that their reduced workload allowed them to provide better care to those clients who did visit the clinic, and they felt that the CARG model should be sustained in the future. CARG members reported that by decreasing the frequency of clinic visits, CARGs saved them time and money, reducing previous barriers to collecting ART and improving adherence. CARG members also valued the emotional and informational support that they received from other members of their CARG, further improving adherence. Multiple healthcare workers did express concern that CARG members with diseases that begin with minor symptoms, such as tuberculosis, may not seek treatment at the clinic until the disease has progressed. Conclusions We found that healthcare workers and clients overwhelmingly perceive CARGs as beneficial. This evaluation demonstrates that the CARG model can be successfully implemented on a national scale. These early results suggest that CARGs may be able to simultaneously improve clinical outcomes and reduce the workload of healthcare workers distributing ART.

Outcomes of Three- Versus Six-Monthly Dispensing of Antiretroviral Treatment (ART) for Stable HIV Patients in Community ART Refill Groups: A Cluster-Randomized Trial in Zimbabwe

“…ART, antiretroviral treatment; CARGs, community ART refill groups; WHO, World Health Organization. 30 VS in the three-monthly CARG arm was very high (99%) among participants with VL results. VS in the sixmonthly CARG arm was marginally reduced; however, accurate estimation of VS in this arm was hindered by low VL result availability.…”

Community Group-Based Models of Medication Delivery: Applicability to Cardiovascular Diseases

“…A qualitative study in Zimbabwe [ 22 ], evaluating the perceived effects of community ART refill groups (this program grew out of the successful program implemented in Tete, Mozambique).…”

“…The Mozambique program in particular inspired two similar programs to be implemented in Southern Haiti and Zimbabwe [ 22 23 ]. Both of these programs have reported high rates of satisfaction from both patients and care providers, and have empowered patients in their own HIV care [ 22 23 ].…”

Understanding how community antiretroviral delivery influences engagement in HIV care: a qualitative assessment of the Centralised Chronic Medication Dispensing and Distribution programme in South Africa

“…Similar findings have been reported in qualitative assessments of community adherence clubs in Mozambique, Kenya, Malawi, Zimbabwe and South Africa, which found reductions in clinical visits, waiting times and transport costs for clients. [15][16][17][18][19] Competencies The material challenges to attending clinics interacted with other components of the social practice of engagement in HIV services. For example, in our study and in another study from South Africa, 20 rushed clinical appointments impeded communication with nurses, meaning there was no time for healthcare workers to equip patients with the competencies required to engage with HIV services and learn about taking ART.…”

“…These findings are similar to a study of community adherence groups in Zimbabwe, where healthcare workers were worried about delayed access to care, while clients were happy to spend less time in clinics, and felt 'empowered to visit the clinic whenever they needed'. 19…”