Differentiated Models of Care: Encouraging ART Patient Retention into Care

 

Nessia Tembo on her way to Matero Main Clinic to collect her medication

Community based ART delivery models have been shown to reduce the burden and strain on the local health system. These models have shown improved outcomes that include better patient retention in care, reduced clinic congestion, and patient satisfaction.

Nessia Tembo of Matero was one of the over 400 participants  who took part in the CIDRZ Fast Track Model, one of the four differentiated models of care implemented during the Community ART for Retention in Zambia study through funding from the Bill and Melinda Gates Foundation. The other three were Community Adherence Group(CAG), Urban Adherence Group (UAG) and Streamlined ART Initiation (START).

Nessia shared her experience, “I was working part time and usually getting leave from work to go the health facility would be a challenge and for fear of losing my job, I would default going for my clinical  appointment just to keep my job. The hours I would spend from having my file pulled to collecting my drugs were long. When the Fast Track model was introduced, I spent less time at the health facility during my ART visits giving me enough time to go back to work and even attend to other family engagements.”.

Nessia receiving her ARV’s from the Pharmacist at Materos Main Clinic

“It is sad that the study has come to an end. If only those of us that took part in the study could be trained and mentored, we would form groups to ensure continuity of the model”.

The Zambian Ministry of Health had authorised  implementing partners to pilot different models of community-based ART service delivery to determine best models of dealing with retention into care of HIV positive clients.

This was in response to the challenges that the health sector was facing. Under the Community ART Study (CommART), CIDRZ conducted a study whose objectives were:

  1. To determine the acceptability, appropriateness, and feasibility of a differentiated care system in Zambia.
  2. To evaluate the effectiveness, efficiency, and health care quality of a differentiated care system that includes targeted models of care.
  3. To develop a “methodologic” toolkit for assessment of local needs and preferences and for implementation during scale-up of differentiated care models in this and in other contexts.

Four models were piloted: one Community model and three facility models. These were the Community Adherence Groups (community model), and the Urban Adherence Groups, FastTrack and Streamlined ART Initiation (facility models).

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