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HIV Self-help groups may increase retention in care in Mozambique

HIV Self-help groups may increase retention in care in Mozambique. Sabrina Pestilli , Jara Llenas-García , Erling Larsson, Michael Hobbins , Jochen Ehmer , Philip Wikman . IAS 2013. Background. Loss to follow-up is the most common cause of attrition (56%)¹

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HIV Self-help groups may increase retention in care in Mozambique

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  1. HIV Self-help groups may increase retention in care in Mozambique Sabrina Pestilli, JaraLlenas-García, Erling Larsson, Michael Hobbins, JochenEhmer, Philip Wikman. IAS 2013

  2. Background Loss to follow-up is the most common cause ofattrition (56%)¹ Logistical challenges cause defaulting fromART ² : distance to services transport cost work and family responsibilities Barriers at the health centre lead to defaulting fromcare³: long waiting time lack of support and information poorqualityof the health services  Self help groups of HIV patients appear to increase retention in care while decreasing financial/logistic/social barriers to care 4 ¹ Fox et al. Trop Med Int Health 2010; ² Geng et al JAIDS 1999;³ Miller at al Trop Med IntHealth2010; 4Decroo et al JAIDS 2011

  3. Objectives To evaluate the feasibility of Self-Help Groups (SHG) of HIV+ people in a secluded area of Northern Mozambique To evaluate the retention into care of HIV+ people in SHG vs. HIV+ people not in SHG

  4. Context Chiure district, Cabo Delgado ~ 250,000 inhabitants 11 Health Centres 1 health staff/ 5,812 people 3 health centres providing ART, 2 of them initiating ART Chiure

  5. HIV in the Chiure District HIV prevalence: 4%¹ Estimated number of HIV+ individuals: 8,472 In need of ART: 3,122 Enrolled in ART: 1,242 pts Attrition rate 32% ² ²Provincial Health Directorate 2011 ¹ Provincial Health Directorate 2012

  6. Health Centre Conditions Lack of health staff Distant Poor management «Quantity vs. Quality»

  7. Health Centre Conditions Lack of health staff Distant Poor management «Quantity vs. Quality» • HIV patients on treatment: • With HIV treatment experience • Without signs of complications • should not frequent the health centre every month to fetch pills

  8. HIV Self Help Group A group of up to 6 members (HIV+ patients in treatment) with 1 focal point SHG members: 1. Rotationally collect ART drugs in HC and distribute to others 2. Monitor other members adherence/outcomes 3. Provide social support 4. Have a clinical consultation/CD4 every 6 months Focal point: 1. Coordinate with the HC 2. Monitor members adherence and health 3. Organize a SHG meeting once per month

  9. HIV Self Help Group Criteria to form SHG: 1. 2-6 pts living in the same community or geographic area 2. Patients≥16 years 3. Ptsstable on treatment ≥6 months 4. Pts clinically stable 5. CD4 count > 200 cell/ul 6. Pts in first line 7. Motivation to be in SHG

  10. Potentialbenefits ¹: • Timesavings (patient and health staff) • Money savingforpts (lesstripsto the healthcentres) • Efficiencyofhealthcentrevisit • Stigma reduction • Reductionofattrition • Risks: • Decreasing treatment quality and follow up • Needs regular monitoringvisitsfromhealth staff toensurequality • ¹Decrooet al JAIDS 2011

  11. Method Participants: From March 2011 – December 2012:  27 groups with 140 pts Inclusion Criteria: ≥16 years of age On ART ≥6 months (a pre-requisite to be included in SHG). Method for Analysis Retrospective comparison of HIV+ patients on ART using same inclusion criteria for SHG and non-SHG group Fisher exact test for the categorical variables comparison Student-t-test or Mann-Whitney-U-test for the continuous variables comparison

  12. Results: Characteristics • Gender imbalance between SHG and Non-SHG

  13. Results: Outcome • Outcome (death) is similar betweengroups • Significantly less LTFU in the SHG • Significantly less time of follow upduringthe same time period in the Non-SHG

  14. Conclusions SHG strategy was wellaccepted Exit rate from SHG is low 13.6% ( 2 LFU, 6 deaths, 8 pregnancy,1 TB, 1 in 2ndline,1 epilepsy) Retention in care appears improved, but Selection bias is likely to contribute to the seen effect Demand in the neighbouring communities increase! The pilotedstrategyhas now been expanded to every district in Cabo Delgado province and nationwide.

  15. Acknowledgements Allpatients and staff in Chiure ColleaguesfromSolidarMedMozambique (J. Garcia, P. Wikman, E.Larsson) ColleaguesfromSolidarMedLucerne (J. Ehmer, M. Hobbins)

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