Community Members Work Together to Reduce Cost and Increase Adherence to ART

December 2nd, 2019 | Viewpoint


Dorothy lives in northern Uganda’s rural Kwania district, home of fishing communities that have high HIV prevalence. The local health facility in Aduku sub-county reports an average of 15 new HIV clients every month. For Dorothy, who herself is HIV-positive, traveling to the community drug distribution point (CDDP) each month to refill her antiretroviral (ARV) medication costs her significant time and money. And once she arrived, the crowded CDDP, with its long wait-times, further discouraged her and other people from getting their vital medications.

People who live with HIV (PLHIV) need to adhere to and remain on antiretroviral therapy (ART) to stay healthy and eliminate their ability to transmit the virus to others. The USAID Regional Health Integration to Enhance Services-North (RHITES–N) Lango project is applying the community client-led ART delivery (CCLAD) model, which trains PLHIV to distribute ARV medications directly to their peers, which drastically reduces the time and money spent getting to the CDDP. Stable CCLAD clients have the opportunity to join a community peer support group (PSG), whose members take turns picking up drug refills from the CDDP. USAID RHITES-N, Lango trains and mentors health workers, linkage facilitators, and village health team members to form and manage PSGs.

Since Dorothy joined and became a chairperson of one of the 79 CCLAD groups and a PSG member, adhering to ART has become much easier.

“I used to go to the facility every month for refills on an individual basis but now I only need to go twice a year. When it is one person’s turn to get a viral load count, that person travels to the facility. The refills last for three months, which gives each member ample time to arrange transportation to the facility when it is his or her turn,” explains Dorothy.

James Awong, who is a clinical officer and ART clinic in-charge of Aduku Health Center IV in Aduku, agrees that CCLAD improves access to and retention in HIV care. “CCLAD helps decongest the CDDP and relieves patients of the costs associated with long wait-times and transportation to and from the facility. Additionally, CCLAD empowers patients to manage their own health.”

CCLAD participants say that that the program has reduced HIV-related stigma in communities, and that PSGs create unity among members, who have gone beyond picking up medications in shifts to helping each other financially and organizing social activities like gardening.

By strengthening CCLAD, the USAID RHITES-N, Lango is increasing PLHIV retention in care, and viral load coverage and suppression rates. These outcomes are contributing to the project’s greater goal of increasing the use of high-quality integrated health services and improving the overall health of individuals, families, and communities in the Lango sub-region.

Written by USAID RHITES-N, Lango Staff

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