20th International AIDS Conference - Melbourne, Australia

Abstract

MOPE403 - Poster Exhibition


Expanding ART delivery through a client led approach at a Ugandan NGO: pilot experiences at TASO Uganda Limited

T. Nabwire Chimulwa1, A. Kasibula2, A. Kateeba3, B. Bakashaba4, M.B. Etukoit5, S. Nantume6

1The Aids Support Organisation (TASO) Uganda Limited, Programs Management, Kampala, Uganda, 2TASO Mulago, Medical Services, Kampala, Uganda, 3TASO Masaka, Psychosocial Services, Masaka, Uganda, 4TASO Headquarters, Programs Management Directorate, Kampala, Uganda, 5TASO Uganda Limited, Executive Director, Kampala, Uganda, 6TASO Uganda Limited, Psychosocial Services, Kampala, Uganda

Background: Annual enrollment of PLHIV on HAART has increased to an estimated 400,000 in Uganda; with TASO contributing over 15%. Although TASO is accredited to offer ART, the facilities are congested (provider-patient ratio at 1: 86). This limits patient-provider interaction; creates lost to follow up patients; inadequate patient monitoring; poor adherence and therefore poor treatment outcomes. The purpose of pilot implementation of the Community Client-led ART Delivery Model (CCLAD) was to increase accessibility to ART through patient involvement and task-shifting so as to expand universal access to treatment while maintaining high quality services.
Description: 1,254 PLHIV receiving treatment from TASO for more than 4 years were selected and screened for clinical and psychosocial eligibility using a standard criteria, educated about the model; organized in peer support groups (PSGs) of 7-10 members; selected their group leaders (using a standard selection criteria); oriented leaders about their roles; identified ARV drug delivery points and appointments set and ARV re-fills made for 6 months. Pre-packing of each patient''s drugs is done, drugs labeled by name and unique identifier. The leader acknowledges receipt of the members'' drugs and ensures all the members acknowledge receipt on delivery. Patient monitoring is conducted monthly by Expert patients and counselors. Refills are conducted every 2 months while clinical reviews are conducted every 6 months.
Lessons learned: 60% of PLHIV were eligible for transition into CCLAD; 100% eligible overwhelmingly embraced the model because it reduced waiting time for ART refills, patients were involved in managing their health; PSGs provided peer psychosocial support; reduced transport costs. There is observable reduction in staff at a drug distribution point (from 8 to 5 hours) due to reduction in provider-patient ratio; enhanced patient follow up; decongested drug distribution points; better care for new naïve patients. However, illiteracy level of PSG leaders was noted to affect reporting and documentation.
Conclusions/Next steps: ConclusionsThe CCLAD model pilot experiences demonstrate evidence of a locally grown innovative approach to community health systems delivery that is likely to reduce health facility congestion, empower patients to take charge of their health thereby increase accessibility to ART thus contributing to universal treatment access.

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