title: A qualitative assessment of a community antiretroviral therapy group model in Tete, Mozambique.
abstract: BACKGROUND
  To improve retention on ART, Médecins Sans Frontières, the Ministry of Health and patients piloted a community-based antiretroviral distribution and adherence monitoring model through Community ART Groups (CAG) in Tete, Mozambique. By December 2012, almost 6000 patients on ART had formed groups of whom 95.7% were retained in care. We conducted a qualitative study to evaluate the relevance, dynamic and impact of the CAG model on patients, their communities and the healthcare system.
  
  
  METHODS
  Between October 2011 and May 2012, we conducted 16 focus group discussions and 24 in-depth interviews with the major stakeholders involved in the CAG model. Audio-recorded data were transcribed verbatim and analysed using a grounded theory approach.
  
  
  RESULTS
  Six key themes emerged from the data: 1) Barriers to access HIV care, 2) CAG functioning and actors involved, 3) Benefits for CAG members, 4) Impacts of CAG beyond the group members, 5) Setbacks, and 6) Acceptance and future expectations of the CAG model. The model provides cost and time savings, certainty of ART access and mutual peer support resulting in better adherence to treatment. Through the active role of patients, HIV information could be conveyed to the broader community, leading to an increased uptake of services and positive transformation of the identity of people living with HIV. Potential pitfalls included limited access to CAG for those most vulnerable to defaulting, some inequity to patients in individual ART care and a high dependency on counsellors.
  
  
  CONCLUSIONS
  The CAG model resulted in active patient involvement and empowerment, and the creation of a supportive environment improving the ART retention. It also sparked a reorientation of healthcare services towards the community and strengthened community actions. Successful implementation and scalability requires (a) the acceptance of patients as partners in health, (b) adequate resources, and (c) a well-functioning monitoring and management system.
authors.affiliation: Departement of Public Health - Institute of Tropical Medicine, Antwerp Belgium.
authors.forename: Freya
authors.initials: F
authors.lastname: Rasschaert
authors.affiliation: Médecins Sans Frontières - Tete, Mozambique.
authors.forename: Barbara
authors.initials: B
authors.lastname: Telfer
authors.affiliation: Médecins Sans Frontières - Tete, Mozambique.
authors.forename: Faustino
authors.initials: F
authors.lastname: Lessitala
authors.affiliation: Médecins Sans Frontières - Tete, Mozambique.
authors.forename: Tom
authors.initials: T
authors.lastname: Decroo
authors.affiliation: Médecins Sans Frontières - Maputo, Mozambique.
authors.forename: Daniel
authors.initials: D
authors.lastname: Remartinez
authors.affiliation: Médecins Sans Frontières - Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Biot
authors.affiliation: Ministery of Health - Tete, Mozambique.
authors.forename: Baltazar
authors.initials: B
authors.lastname: Candrinho
authors.affiliation: Ministery of Health - Maputo, Mozambique.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mbofana
authors.affiliation: Departement of Public Health - Institute of Tropical Medicine, Antwerp Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Damme
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility; D006801:Humans; D008962:Models, Theoretical; D009073:Mozambique; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012111:Residence Characteristics
chemical_list: D044966:Anti-Retroviral Agents