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Community-supported models of care for people on HIV treatment in sub-Saharan Africa

Community-supported models of care for people on HIV treatment in sub-Saharan Africa. M. Bemelmans, S. Baert , E. Goemaere , L. Wilkinson, M. Vandendyck , G. Van Cutsem , C. Silva, S. Perry, E Szumilin , R. Gerstenhaber, L. Kalenga , M. Biot , N. Ford MSF OCB

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Community-supported models of care for people on HIV treatment in sub-Saharan Africa

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  1. Community-supported models of care for people on HIV treatment in sub-Saharan Africa M. Bemelmans, S. Baert, E. Goemaere, L. Wilkinson, M. Vandendyck, G. Van Cutsem, C. Silva, S. Perry, E Szumilin, R. Gerstenhaber, L. Kalenga, M. Biot, N. Ford MSF OCB Scientific day 2014

  2. STABLE patient on ART Monthlyclinicvisit for consultation and ART refill How to deal with a growing cohort of stable patients on ART? Peter Casaer Peter Casaer

  3. Community-supported models of care DR Congo Malawi Mozambique South Africa

  4. What are the benefits for patients and healthsystems acrossthesecommunity-supportedmodels?

  5. Methods • Assessing 4 approaches to manage stable patients on ART • From a patient and health system perspective • Reviewing routinely collected programme data as well as published studies

  6. Results “The advantage of being in a CAG is that you can do other small jobs when you know that a group member will collect ART for you. This makes things easier “ CAG Group member, Tete, Mozambique Rasschaert, 2014

  7. Transportation costs 3x less at PODI versus hospital Time spent for ART collection 14 minutes at PODI versus 85 minutes at hospital Jocquet, 2011

  8. 69% reduction in ART refillvisits Billaud, 2014

  9. Improvehealthoutcomes High retention in care Project data, Chiradzulu, 2013 Luque-Fernandez, 2013 Kalenga, 2013 Preliminary data, Tete, 2014

  10. Improvehealthoutcomes Betterretentionthan in conventional care Eligible & joined Eligible & did not join Project data, Chiradzulu, 2013 Luque-Fernandez, 2013 Kalenga, 2013 Preliminary data, Tete, 2014

  11. “… belonging to a group strengthens people. Moreover, being united people become mentally stronger during treatment compared to those who do it individually.” CAG leader, Tete, Mozambique Rasschaert, 2014

  12. Lower Service Provider Costs Samantha Reinders Bango, 2013

  13. Strong publication and dissemination efforts

  14. Major impact on national & international policy WhatisMSF’sresponsability in national roll-outs?

  15. Critical enablers Brendan Bannon André Francois Realistic planning Flexible adaptations Recognition of lay workers Acces to quality clinical management Miguel Cuenca Brendan Bannon Reliable monitoring system Robust drug supply

  16. Conclusion • Community supported models respond to the needs of a growing cohort of stable patients on ART and their health care workers • Adaptation of these models is ongoing to include other HIV+ patients and allow for a wider application to other diseases • Further analysis and advocacy is needed to ensure models are adapted to contexts and critical enablers are in place André Francois

  17. Acknowledgements • Patients living with HIV in sub-Saharan Africa • MSF and Ministry of Health staff in our projects in sub-Saharan Africa • Co-authors André Francois

  18. Extra’s

  19. samumsf.org

  20. Improve testing & linkage to care 3168 tested for HIV 8,6% HIV + 40% joined CAG 42% eligible for ART 89% eligible and started ART Project data Changara, 2013

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