Abstract:
Introduction: the increasing number of people
receiving antiretroviral therapy (ART) in sub-
Saharan Africa has stressed already overburdened
health systems. A care model utilizing community-
based peer-groups (ART Co-ops) facilitated by
community health workers (CHW) was
implemented (2016-2018) to address these
challenges. In 2018, a post-intervention study
assessed perceptions of the intervention. Methods:
forty participants were engaged in focus group
discussions consisting of ART Co-op clients, study
staff, and health care providers from Kitale HIV
clinic. Data were analyzed thematically for content
on the intervention, challenges, and
recommendations for improvement. Results: all
participants liked the intervention. However, some
reported traveling long distances to attend ART Co-
op meetings and experiencing stigma with ART Co-
ops participation. The ART Co-op inclusion criteria
were considered appropriate; however, additional
outreach to deliberately include spouses living with
HIV, the disabled, the poor, and HIV pregnant
women was recommended. Participants liked CHW-
directed quarterly group meetings which included
ART distribution, adherence review, and illness
identification. The inability of the CHW to provide
full clinical care, inconvenient meeting venues, poor
timekeeping, and non-attendance behaviors were
noted as issues. Participants indicated that
program continuation, regular CHW training,
rotating meetings at group members´ homes,
training ART Co-ops leaders to assume CHW tasks,
use of pill diaries to check adherence, nutritional
support, and economically empowering members
through income generation projects would be
beneficial. Conclusion: the intervention was viewed
positively by both clinic staff and clients. They
identified specific challenges and generated
actionable key considerations to improve access
and acceptability of the community-based model of
care.
