Abstract
BackgroundThe focus of the community anti-retroviral therapy Group model is on drug refill, adherence and support groups. However, laboratory services are completely neglected in this model, and stable patient still have to go to the clinic for blood draws after drugs refills from the community. Due to the introduction of new ART drugs, the guidelines now recommend the use of viral loads to guide decision in switching all patients from NNRTI to dolutegravir based first line ART regimens. But the national viral load testing coverage stands at 37% and and falls short of meeting the global UNAIDS and phlebotomy delivery system is congested. The purpose of this study was to identify the perceptions in decentralizing phlebotomy services into the community anti-retroviral therapy Group model.MethodA qualitative case study design was used. Data were collected through ten Focused group discussions among community anti-retroviral therapy Group members, community and health care workers at anti-retroviral therapy clinics and in-depth interviews with five key informants. Data were managed with the help of Nvivo version 10 and analyzed using thematic method.ResultsPositive perceptions were identified as those which contributed to decongesting phlebotomy rooms, reduced missing phlebotomy appointments, work Load, and lost results. Improved quality of phlebotomy service delivery and testing coverage, innovative access to laboratory services and encouraged patient’s accountability. The negative perceptions were compromised sample integrity, inability to perform prevention control and patients less contact with clinicians.ConclusionThe study has demonstrated that decentralizing phlebotomy services within the CAG model has greater potential to improve the quality of services delivery for patients. In addition, it has perceived threats on the quality of specimen collected, patient’s safety, and health care.
Highlights
The focus of the community anti-retroviral therapy Group model is on drug refill, adherence and support groups
Siwingwa et al BMC Health Services Research (2019) 19:570 and physical infrastructure currently are not adequate to accommodate national scale up of antiretroviral therapy (ART). They have adapted the Differentiated service delivery (DSD) which is a client-centered approach that simplifies and adapts Human Immunodeficiency Virus (HIV) services across the cascade in order to reflect the preference and expectations of various groups of people living with HIV (PLHIV) while reducing unnecessary burdens on the health system
Community Antiretroviral Therapy Group (CAG) model emanated from Mozambique in 2012 and this was prompted by the country’s high attrition rates, limited number of ART clinics, an influx of patients and longer distances covered to a health facility
Summary
The focus of the community anti-retroviral therapy Group model is on drug refill, adherence and support groups. Siwingwa et al BMC Health Services Research (2019) 19:570 and physical infrastructure currently are not adequate to accommodate national scale up of ART. CAG model emanated from Mozambique in 2012 and this was prompted by the country’s high attrition rates, limited number of ART clinics, an influx of patients and longer distances covered to a health facility. This model constituted a group of six people and every month a different group representative was chosen and travelled to the clinic to collect drug at ART clinic on behalf of the other group members. The focus was on drug refill, adherence and support groups [7]
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