I want to thank Moses Luhanga for sharing information about Community anti-retroviral therapy (ART) Groups (CAGs). A lot of information in this article today is based on the information he shared and an Médecins Sans Frontières (MSF) report Community ART Group (CAG) Toolkit Lessons Learnt from Implementing CAGs in Thyolo, Malawi, Bringing Treatment Closer to Home and Empowering Patients.
Let me first say that CAGs are self-formed groups of stable patients on ART from a community in the same geographic location. The key principles of the groups are members who take turns collecting antiretroviral medicines at the clinic; clinical consultation and blood drawing is done in-group at the clinic or when a member needs a drug refill; members perform community-based delivery of medications; and provide adherence support and monitor treatment outcomes.
CAGs were first piloted in Thyolo in 2012 and to date over 5 000 PLHIV (People living with HIV) have joined CAGs. The MSF report states that CAGs have “proved extremely successful with excellent adherence and retention rates and minimal defaulter rates as compared to the conventional ART programme outcomes.” CAG has had benefits not only for PLHIV but also reduced congestion at health facilities.
PLHIV face a number of challenges with drug adherence and visits to the clinic which can be costly and time consuming. The rapid scale up of ART has not met with an equal increase in resources at health care facilities that have a lack of staff and congested waiting rooms. Studies in Sub-Saharan Africa have shown that on average, nearly a third of the patients had been lost during follow-up within the first two years on antiretroviral therapy.
CAGs consist of four to eight members. Every month, before the visit to the clinic the group meets in the community. The group representative chairs the meeting and counts the medicines of each member (adherence review). Any new symptom, adherence problem or intended interruption is discussed and documented.
The representative changes each month and their appointment follows several criteria: if someone is not feeling well or needs to do a CD4 count test or to be weighed. If no one meets these requirements, s/he is chosen according to a pre-established calendar. All of the members of the group hand their “patient book” to the representative.
In the clinic, the representative first undergoes a consultation in his/her own name. Then s/he meets the health staff that prescribes the ARV and prophylactic medicines needed by the whole group. The patient’s books are updated and the medicines are packed under each patient’s name to prevent delivery mistakes. The representative returns to the community and hands out the medicines to each member, returns the patient book and, if necessary, tells them to go to the health centre for follow-up.