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DIRECÇÃO PROVINCIAL DE SAÚDE TETE MOÇAMBIQUE

DIRECÇÃO PROVINCIAL DE SAÚDE TETE MOÇAMBIQUE. The effect of Community ART Groups on retention-in-care among patients on ART in Tete Province, Mozambique

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DIRECÇÃO PROVINCIAL DE SAÚDE TETE MOÇAMBIQUE

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  1. DIRECÇÃO PROVINCIAL DE SAÚDE TETE MOÇAMBIQUE The effect of Community ART Groups on retention-in-care among patients on ART in Tete Province, Mozambique Tom Decroo1, Barbara Telfer1, Carla Das Dores2, Balthasar Candrinho2, Natacha Dos Santos1, Alec Mkwamba1, Sergio Dezembro1, Mariano Joffrisse1, Tom Ellman3, Carol Metcalf3 1Médecins Sans Frontières, Tete, Mozambique; 2Direcção Provincial de Saúde Tete, Moçambique; 3Médecins Sans Frontières, Southern Africa Medical Unit, Cape Town, South Africa

  2. Mozambique • Population 25 million • 70% live rural • Healthworkforce gap • 10.5% adult HIV prevalence 1 • 1.5 million live with HIV 1 • ART • 53% coverage 1 • Rural areas: up to 50% attrition @ 3 years 2 (1UNAIDS, 2016; 2Wandeler, 2012)

  3. Tete Province • LTFU hampered ART scale-up • Distances, queuing, lack of information 1 • Tracing not effective 2 • Community ART Groups • Patients > 6 months on ART and stable join peer groups for refill, reporting & referral (1 Caluwaerts, 2009; 2 Posse, 2009)

  4. CAG dynamic

  5. Research question • Does CAG harm? • Mixed methodsstudy • How doesretention-in-care in CAG compare withretention-in-care in conventional care • Perceptions of & experienceswith CAG (presentedelsewhere)

  6. Methods • Retrospectivecohortstudy • File review in 8 clinics • Peri-urban(Moatize, Songo) • Rural (Changara, Mutarara, Manje, Zobue, Chitima, Boroma) • Clinicswith > 80 % in CAG wereexcluded (Missawa, Marara, Kaounda, Mavutze Ponte) • Studyperiod: Feb 2008 (start of CAG) – April 2012

  7. Methods • Study inclusion criteria: • Active @ 6 monthson ART in the studyperiod • 15 - 60 years old • Survival analysis • Follow-up time: started at “date of 6 monthson ART” • Outcome: attrition (deadorlost to follow-up) • CAG participation: time-dependentcovariate • Multivariate Cox regression: effect of CAG participation on attrition, adjusted for age, sex & type of healthfacility

  8. Results 9 266 patiënts on ART 8 health facilities Exclusion 3 638 > 6 months on ART beforethestudyperiod 2 324 < 6 months on ART duringthestudyperiod 364 aged < 15 or > 60 98 had anunknownage 436 in CAG before 6 months ART 2 406 6 month on ART in thestudyperiod Between 15 and 60 yearsold

  9. Results – characteristics

  10. Results – retention in care 97.5% 82.3% P< 0.0001

  11. Results – predictors of attrition HR= Hazard Ratio; aHR= adjusted Hazard Ratio * Adjusted for calender time (by semester)

  12. Key findings & interpretation • Retention in care in CAG higher than in conventional care • Effect of CAG on adherence is unknown • Qualitative data showed advantages (peer support, less barriers), enablers (counsellors), and pitfalls (selective enrolment in CAG) 1 • Limitations • Selection bias • Potential confounders such as CD4, psycho-social characteristics and distance to clinic not available (1 Rasschaert, 2014)

  13. Implications & perspectives • Peer-led community-based ART delivery works • Continue CAG scale-up • Adapt model : • Include second-line, TB/HIV co-infected, adolescents, early ART, … • Comprehensive community-based care • One size doesn’t fit all!

  14. Thankyou ! • Patients, CAG members • MSF staff • Ministry of Health • Richard White

  15. Extra slides

  16. 92%

  17. @ CAG: . Time & cost savings . Protective environment . Peer support Selection (affinity, trust) @ Health Facility: . Time for sick patients . Information loop Need for counsellors @ Community: .HIV awareness .Less stigma Information not always correct

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