title: Community ART Support Groups in Mozambique: The Potential of Patients as Partners in Care.
abstract: BACKGROUND
  High rates of attrition are stymying Mozambique's national HIV Program's efforts to achieve 80% treatment coverage. In response, Mozambique implemented a national pilot of Community Adherence and Support Groups (CASG). CASG is a model in which antiretroviral therapy (ART) patients form groups of up to six patients. On a rotating basis one CASG group member collects ART medications at the health facility for all group members, and distributes those medications to the other members in the community. Patients also visit their health facility bi-annually to receive clinical services.
  
  
  METHODS
  A matched retrospective cohort study was implemented using routinely collected patient-level data in 68 health facilities with electronic data systems and CASG programs. A total of 129,938 adult ART patients were registered in those facilities. Of the 129,938 patients on ART, 6,760 were CASG members. A propensity score matched analysis was performed to assess differences in mortality and loss to follow-up (LTFU) between matched CASG and non-CASG members. Propensity scores were estimated using a random-effects logistic regression model. The following covariates where included in the model: sex, educational status, WHO stage, year of ART initiation, age, CASG eligibility, CD4 cell count category, weight, and employment status.
  
  
  RESULTS
  Non-CASG participants had higher LTFU rates (HR 2.356; p = 0.04) than matched CASG participants; however, there were no significant mortality differences between CASG and non-CASG participants. Compared with the full cohort of non-CASG members, CASG members were more likely to be female (74% vs. 68%), tended to have a lower median CD4 counts at ART initiation (183 cells/m3 vs. 200cells/m3) and be less likely to have a secondary school education (15% vs. 23%).
  
  
  CONCLUSIONS
  ART patients enrolled in CASG were significantly less likely to be LTFU compared to matched patients who did not join CASG. CASG appears to be an effective strategy to decrease LTFU in Mozambique's national ART program.
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique.
authors.forename: Kebba
authors.initials: K
authors.lastname: Jobarteh
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States of America.
authors.forename: Ray W
authors.initials: RW
authors.lastname: Shiraishi
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique.
authors.forename: Inacio
authors.initials: I
authors.lastname: Malimane
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique.
authors.forename: Paula
authors.initials: P
authors.lastname: Samo Gudo
authors.affiliation: Medical Department, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Decroo
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States of America.
authors.forename: Andrew F
authors.identifier: http://orcid.org/0000-0001-5089-9163
authors.initials: AF
authors.lastname: Auld
authors.affiliation: Mozambique Ministry of Health, Maputo, Mozambique.
authors.forename: Vania
authors.initials: V
authors.lastname: Macome
authors.affiliation: Mozambique Ministry of Health, Maputo, Mozambique.
authors.forename: Aleny
authors.initials: A
authors.lastname: Couto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006678:HIV / Q000472:pathogenicity*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009073:Mozambique / Q000453:epidemiology; D012189:Retrospective Studies