Walking through life together - Community HIV ART adherence in rural Mozambique
Morrumbala District of Zambézia Province, Mozambique
Anabela Chico, 41, is one of the beneficiaries of the Community Adherence Support Groups implemented by the Mozambican Ministry of Health in 2010, known locally as Grupos de Apoio a Adesão Comunitária (GAACs). Anabela heard of the GAAC strategy through the Ndichichenge association, where she had been a member since December 2011. Some fellow association members shared information from the health facility that explained the advantages of being in a GAAC, whereby group members rotate responsibility for traveling to the health facility to pick up all antiretroviral (ARV) medication for the group. Soon after hearing this, Anabela became very interested in joining.
“Before being in a GAAC I had a lot of trouble getting to the health facility for my medication. At times I had a fever, but it was the day to go to the health facility so I had to go and stand in line, waiting until my legs ached. I was always very tired. When I entered the GAAC, I was able to get plenty of rest and still receive my meds every month. If I get sick before reaching my turn to go to the hospital for the group, I know I still have to go there to meet with the nurse. But if that is not the case, on the day of my GAAC meeting I give my card to the designated member going to the health facility for our medications. We discuss some problems and receive advice with our focal point on taking the tablets. So I am very happy and grateful, because I no longer spend my life in the hospital. I can have my life a little quieter and devote myself to other tasks.”
Medisson Joaquim, 37, has been a member of the Ndichichenge GAAC association [GAF2] since December 2011. He first heard of GAACs in a ‘Positive Tea’ meeting at the Morrumbala health facility. During this meeting the members identified and discussed problems they had encountered as well as how to minimize the difficulties experienced in reaching the clinic every month for medication and counseling. In this meeting, the Positive Tea Health Counselor explained aspects of the GAAC strategy, which involves 3-6 association members formed into a support group, rotating health facility visits until all participating members have a turn. With this strategy, in addition to reducing the number of necessary visits to the health facility, the issue of distance is less of a problem and the long queues at the health facility are diminished.
Medisson returned home from the meeting and gathered some community members to share this information from the health facility and invite them to form a GAAC. Today, a year later, he reports:
“The GAAC strategy came as a relief to the many problems related to time spent in the health facility and extensive waiting in long lines to be attended. Now I am very happy with the strategy. For example, I have gone 5 months without going to the clinic to collect my pills. So my time in the health facility has diminished. I have time to rest, and I can do other activities of mine. Each of the 6 group members will collect medications once a month. This involves recording the main problems occurring within the group and counting the remaining tablets in each medication bottle before collecting the health cards of members. The selected group member then provides a group report to the psychologist at the health facility. I am very grateful for the support of the entire team working with the GAAC strategy, and we are always available to meet if there are ever any questions.”
One psychologist, Jafar, reported that, “today we already have about 84 GAACs in Morrumbala comprised of both male and female patients that have been on ART for more than 6 months and met the other eligibility requirements to form the GAAC (above 200 CD4 cells / ul; over 15 years old, the first line ART, and adherent for the last 6 months). Now you can also see greater compliance in GAAC members, greater cohesion between them and the psychosocial support coming from the focal point and beyond, as well as shorter queues of patients in the health facility.”
Today patients participating in GAACs are also actively involved in promoting and protecting their health as well as the health of others through lectures and plays aimed at mobilizing and sensitizing their communities. In the health facility, adherence training for new GAACs continues, and several patients that meet the criteria have already expressed interest in forming new groups. Overall, this initiative appears to be a low-cost solution toward improving adherence to ARV treatment in certain rural areas of Mozambique, and the groups involved are eager to continue strengthening their support for one another.