Joining a Community ART Refill Group

Dear Doctor
I am a woman aged 45. I have recently tested HIV positive. I was immediately started on ARVs.

I am a mother and a tobacco farmer. In my area I have seen one person from a group of people who are said to be HIV positive going to collect medicines for each other. How do I get to introduce myself to them? I really would love to join the group so that when I am busy with my day today duties, someone collects the medicines for me as well.

Tariro

Dear Tariro

Thank you very much for your letter. It is good that you have taken a good look at your lifestyle and your need for medication and you are trying to find a way of making these two work together.

The Republic of Zimbabwe has made strides in Anti-retroviral therapy (ART) service provision and, among other interventions, has adapted the Community ART Refill Group (CARG) model which supports self-formed groups of clients, who are stable in accessing ART. The overall goal of this model is to reduce the burden and challenges for both health care workers and patients in the provision and receipt of ART and improving adherence and retention in care and treatment.

You can only join a CARG after six months of taking your ARVs. Between now and the sixth month you need to visit your health centre so that health personnel can check how you are coping with your treatment.

Let me tell you more about CARGs. They are self-forming groups of HIV-positive persons (who are on ARVs), living in the same community and organised in groups. Each group has a minimum of 10 members. These members take turns to pick up ARVs at the health facility and distribute them among the other group members in the community.

The members of the CARGs manage their own health and share experiences about living positive with HIV.

Despite the decentralisation of ART to the health centers, many patients continue to face difficulties in accessing to ARVs due to long distances from community to the health facility (HC) that supply ARVs.

For an individual who is HIV positive and on ARVs want to join CARG, he or she needs to meet the following criteria:

HIV positive patient willing to be a CARG member

Be stable on ART (without any complication and severe opportunistic Infections).

Be on ART for six months and more.

Last viral load <1000c/ml

Currently not on treatment of TB treatment or any other major OIs.

Be above 15 years of age.

Not pregnant or breastfeeding women.

Access ARVs at the same health facility with other members.

Live in the same community or neighborhood, or share the same social network with other members.

Formation of these groups (CARG) is voluntary. Nurse and Patients Support Groups are there just to facilitate the selection by meeting with those patients on ART either at the facility where they get their refill, villages or in respective support groups.

If the patients are willing and interested to join or form CARG, they are told to find their partners themselves within the neighbourhood. Once they identify members of the group they choose their group leader called focal person.

Then they report to the nurse at the health facility for eligibility screening (to exclude complication while on ART) and registration.A� All the members should be aligned for uniform dates for drug refill, clinical follow up examination and viral load follow up test.

Activities of CARG

The group members at community meet twice every three month at their convenient time and place. The first meeting is done on the day before the refill day and the following meeting is on the refill day after the member comes back from the health facility.

During the pre-refill day meeting all members bring their ARV bottles with the remaining pills.

The focal person counts the remaining pills in the bottle with each member one by one and he records it on the group card (date and remaining pills against each member). Each member signs below where his/her pill count is recorded on the Community Group CardA�A� After doing pill count the group chooses the representative to go to the health facility on the next day (refill day). He/she is then given the other membersa�� bottles with remaining pills and group card to present to the health facility.

The focal person assesses each member if he/she has side effects and records it on the COMMUNITY ART REFILL GROUPrefill form (Form C1). The assessment is repeated every three months thereafter.

The group members pick a representative to go and collect drugs based on rotational basis, every 3 months for routine ARV refills. This will allow the representative to have consultation with the clinician.

Whenever any CARG member feels or is sick (i.e. has fever, headache, etc…), he/she should go to a health facility any time for treatment not waiting the routine ART refill visit.

When the representative comes back from the health facility, the group meets in the afternoon, so that each member should collect his/her supply. The representative hands over the group card back to the focal person.

Every meeting (every three months)

It is the countrya��s sincere hope that the CARGs model will help in ensuring that everyone gets their medicines at all times without struggling.

Continue taking your medicines well and I assure you that you have a long and healthy life ahead.

Yours Doctor