title: Distribution of antiretroviral treatment through self-forming groups of patients in Tete Province, Mozambique.
abstract: BACKGROUND
  As antiretroviral treatment cohorts continue to expand, ensuring patient retention over time is an increasingly important concern. This, together with capacity and human resource constraints, has led to the consideration of out-of-clinic models for the delivery of antiretroviral therapy (ART). In 2008, Médecins Sans Frontières and the Provincial authorities launched a model of ART distribution and adherence monitoring by community groups in Tete Province, Mozambique. PROGRAMME APPROACH: Patients who were stable on ART for 6 months were informed about the community ART group model and invited to form groups. Group members had 4 key functions: facilitate monthly ART distribution to other group members in the community, provide adherence and social support, monitor outcomes, and ensure each group member undergoes a clinical consultation at least once every 6 months. Group members visit the health centre on a rotational basis, such that each group member has contact with the health service every 6 months.
  
  
  RESULTS
  Between February 2008 and May 2010, 1384 members were enrolled into 291 groups. Median follow-up time within a group was 12.9 months (IQR 8.5-14.1). During this time, 83 (6%) were transferred out, and of the 1301 patients still in community groups, 1269 (97.5%) were remaining in care, 30 (2%) had died, and 2 (0.2%) were lost to follow-up.
  
  
  CONCLUSIONS
  The Community ART Group model was initiated by patients to improve access, patient retention, and decongest health services. Early outcomes are highly satisfactory in terms of mortality and retention in care, lending support to such out-of-clinic approaches.
authors.affiliation: Médecins Sans Frontières, Tete, Mozambique.
authors.forename: Tom
authors.initials: T
authors.lastname: Decroo
authors.forename: Barbara
authors.initials: B
authors.lastname: Telfer
authors.forename: Marc
authors.initials: M
authors.lastname: Biot
authors.forename: Jacob
authors.initials: J
authors.lastname: Maïkéré
authors.forename: Sergio
authors.initials: S
authors.lastname: Dezembro
authors.forename: Luisa Isabel
authors.initials: LI
authors.lastname: Cumba
authors.forename: Carla
authors.initials: C
authors.lastname: das Dores
authors.forename: Kathryn
authors.initials: K
authors.lastname: Chu
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006126:Group Processes; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D009073:Mozambique; D010349:Patient Compliance; D015397:Program Evaluation; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents