Background: The WHO advocates for differentiated HIV care and considers a broad range of community-based care models for patients stable on anti-retroviral therapy (ART). These care models aim to better respond to patient needs and to alleviate pressure on health systems caused by rapidly growing patient numbers. Most settings, however, utilized a single community-based care model only. We operationalize a combination of community ART care models in public health sector and assessed early outcomes.
Methods: Three community ART delivery care models were deployed in the rural Shiselweni region (Swaziland), from 02/2015 to 12/2015. First, Treatment Clubs (TC) are groups of 30 patients stable on ART who meet every 3 months at a secondary health facility for patient education and drug-refills. Second, Community ART Groups (CAG) comprise a maximum of 6 patients who alternate to attend the primary health clinic for consultation and pick up drugs for the other group members. Third, Comprehensive Outreach Care (COC) integrates drug refills into existing mobile clinic outreach activities for geographically isolated communities. We described baseline factors at enrolment,and 6 month retention in community care models and proportion of patients transferred back to routine clinical care.
Results: On average, 47 patients enrolled into community-ART care each month: 51.1% into TC
(242 patients in 8 groups), 34.0% in CAG (164 patients in 38 groups) and 14.9% in COC (65 patients in 2 remote communities). All patients had a VL< 1,000 copies/ml, the median CD4 was 512 (TC), 528 (CAG) and 657 (COC) cells/µl (p=0.27), the median age was 40, 40 and 45 years (p=0.11), and 74.8%, 66.5% and 64.6% were females (p=0.03). Retention in care after 6 months was highest in TC (97.5%) when compared to CAG (79.2%) and COC (78.4%) (p< 0.01). 53/471 patients (11.3%) returned back to and were retained in routine clinic care and one (0.21%) was recorded as death in COC.
Conclusions: Concurrent implementation of three community ART care models was feasible. Although a proportion of patients returned back to clinic care, overall ART retention was high and should encourage program managers to apply differentiated care models adapted to their specific setting.