Model mechanics

ART refills

Clinical consultations

Individual/group approach

Group – 1-2 individuals from group collects on behalf of the group and distributes

Individual – clients from the group all come on the same day

Who attends?

Representative client/s

Client

Client recruitment

Where

At facility and in community

By whom

Lay community health model education and promotion in facility waiting rooms
Community village health workers model education and promotion at community events and home visits
Existing community HIV support groups
Clinician suggesting enrolment

Eligibility assessment

At individual clinical consultation

Group formation

Clients (self-forming), or through a counsellor/nurse introducing possible group members to each other

HIV disclosure

Does it happen?

Yes

If yes, where?

Within the group

Annual health care visit schedule for client

3-month supply with VL:

  1. ART refill (in community)
  2. ART refill (in community)
  3. ART refill (in community)
  4. ART refill + VL blood draw + clinical review + rescript (at facility)

3-month supply with no VL:

  1. ART refill (in community)
  2. ART refill + CD4 blood draw + clinical review + rescript (at facility)
  3. ART refill (in community)
  4. ART refill + CD4 blood draw + clinical review + rescript (at facility)

ART refill provision to group meeting location

How

One group representative goes to facility to collect ART refill for all group members and distributes upon return at group meeting venue in community

By

Rotating or nominated group member/s

Up referral (return to standard of care)

Criteria

Facility nurse assesses client to be clinically unstable requiring regular clinical follow up, including:

  • Develops  OI

Facility nurse identifies client with:

  • High VL (>1,000 copies/ml)
  • In absence of VL – evidence of clinical or immunological failure

Women during pregnancy and subsequent follow up of the “HIV-exposed” baby
Where repeated CARG problems observed – failure of member to collect refills or attend facility for clinical review

Communicated by

Facility nurse

Client records

Facility clinical folder

Client care and treatment booklet for all CARG members kept together at facility and completed by nurse when CARG representative attends to collect ART refills for the group with CARG refill form

Monitoring system

At group meeting venue

Client section of CARG refill form

At health care facility

CARG refill form recorded in client and treatment booklet and then entered into ART register

Resources