Ministry of Health, Mozambique gaAc strategy grupos de apoio a adesÃo comunitÁria Community adherence SuPPORT groups Ministry of Health, Mozambique MSF-OCB, Mozambique Rome, 17th of July 2011

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 To improve retention in care of patients on ART through increasing patient involvement Secondary Objectives To improve access, retention and adherence of patients on ART. To enhance the quality of the services and follow-up of patients at the HF. To establish a system of early surveillance to triage medical conditions and situations related to LTFU. To reduce the number of clinical appointments and the workload at the HF. To reinforce the psychosocial support among ART and pre-ART patients. To strengthen the link between the HF and the community.

3 2 1 Strategy Health Facility Home January A B C D E Feb Mar Apr May Member 1 goes home while members 2, 3, 4, 5 and 6 conduct GAAC trips to HF during the following five months GAAC in the community Feb Mar Apr May Jun Home 2 Member 1 returns to community and distributes ARVs to other 5 GAAC members January 1 Reception Consultation Pharmacy Laboratory Counselor 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

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

National Pilot: Methods 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: Roles 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: M&E Proposed M&E Tools ARVs Control Register: To register monthly patient pill-counts and report warnings of potential OIs (filled out in the GAAC community) GAAC Register Book: To register and follow up information about the group members (including basic demographic and treatment follow-up information) GAAC Monthly Report: To track GAAC expansion and trends in GAAC patient retention at the HF, district, provincial and national level

Obrigada !!

Thank you!