Background: TASO Uganda is one of the largest organizations implementing HIV care and treatment institutions in Sub Saharan Africa, caring for over 100,000 people living with HIV. TASO introduced Community drug distribution points model (CDDP) and recently the, Community client led ART delivery model (CCLAD) for stable patients on ART. The main aim of this study is determine adherence outcome among patients on CCLAD.
Description: TASO developed eligibility and exclusion criteria. The CCLAD eligibility criteria were: adherence, poor response to ART (CD4 count consistently below 350 for more than six months), TB co-infection or presence of any malignancies. A data tool tracking client indicators was developed with the help of Peer Leaders. data is captured in one main system to the national data reporting tool. Pre-packaging of drugs, labeled and packed separately, makes distribution of refills to individual clients easier for each client in preparation for delivery. Transport costs: a group of seven to ten clients contributed a nominal user fee to cover the cost of transportation for the leader to collect the drugs each time.
Lessons learned: A total of 62,129 patients were on ART were enrolled in 2015 for this study, 23,113 (37%) were in facility arm, 36,777 (59%) were in CDDP arm, 2799 (14%) were on CLAD arm. The adherence outcome for facility above 95% was 88%, 89% for CCLAD and 89% for CDDP. We learnt that a simple data collection tool facilitated the peers to collect information which is then transcribed to national ART registers. Pre packing of drugs with clear labeling by pharmacy staff enable accurate distribution of ART refills, patients were empowered to take care of the challenging transport cost by jointly contributing to costs for peer leaders to pick group medications
Conclusions/Next steps: CCLAD models achieved similar adherence outcomes compared to facility-based models and community-based drug delivery by facility staff. Peer leaders, as lay ART providers facilitated the smooth implementation of the CCLAD model. CCLAD model should be scaled up for stable patients on ART