Background: The United States Agency for International Development-funded Care and Support to Improve Patients Outcomes Project (CaSIPO) aims to maximize the quality of life for patients on antiretroviral treatment (ART) through provision of comprehensive care and support services in the community. As the South African Government vows to provide access to treatment to all people living with HIV and AIDS, adherence to treatment and retention in care are critical to the sustainability of the ART program.
Description: CaSIPO works with 15 high burden Districts to strengthen community systems to promote patients'' retention in care. Community adherence clubs (CACs) offer a much-needed adherence support structure to stable patients on ART along convenient access to their medications. CaSIPO uses innovative approaches to adapt to local context and establish CACs in rural, semi-rural and urban settings. Working closely with community based organizations (CBOs), ward based outreach teams and clinics, CaSIPO developed their skills and knowledge to provide adherence support, health promotion, nutrition assessment counselling and support, screening for tuberculosis and sexually transmitted infections, family planning education and active referral.
Lessons learned: CaSIPO undertook various capacity development strategies to strengthen the CBOs'' systems and structures and empower them with the necessary tools to provide patients-centred sustainable adherence support. Between June 2016 and December 2017, CaSIPO empowered 194 CBOs across 15 Districts to provide quality comprehensive care and support services to 110,994 HIV stable patients attending 4,526 CACs. Quality is a key driver of retention in care. Through training, mentorship and intensified technical assistance program, CaSIPO established a quality assurance system for community based services resulting in 96% retention in CACs (n=106,781; d= 110,994; December 2017). Over 18-month period, 4,213 of 110,994 CACs patients had exited the clubs, with 69% (2,907) transferred to other decanting modalities and only 7% (295) lost to follow up.
Conclusions/Next steps: South Africa unique and complex public health dynamic led CaSIPO to adopt a mixed approach to provide sustainable and scalable community adherence support structure to ART patients. Strengthening the community system and facilitating linkages between community and health facilities has proven to be critical in promoting retention in care.