Background: Public healthcare facilities are overburdened with large numbers of stable antiretroviral treatment (ART) patients resulting in poor management and long waiting time; community ART Refill Groups (CARGs) are postulated to decongest facilities improving care as one person collects ART at the facility for the whole group. This study explores patient and service provider''s acceptability of CARGs in Zimbabwe.
Methods: As part of a cluster randomized trial to assess effectiveness of 3 and 6-monthly dispensing of ART for stable patients in CARGs, qualitative data were collected in Shona, Ndebele and Venda from October-December 2017 in Beitbridge, Chitungwiza, Gutu, Mberengwa and Zaka districts. Twenty key informant interviews from purposively selected service providers were conducted. 113 females and 42 males newly enrolled in CARGs were randomly selected and participated in focus group discussions from each of the 20 facilities. Translated-transcripts were analyzed for thematic content.
Results: Facility staff welcomed the formation of CARGs linked to their facilities as a solution to decongest facilities, improve care for unstable patients, increased time for patient data compilation and group viral load testing to improve monitoring (the third 90). New CARG members anticipate benefits that include saving on transport costs and reduction in facility visits thereby allowing increased focus on productive activities. Group support through livelihood projects, adherence and defaulter tracing were highlighted to improve retention, lifestyles, and psychological well-being. Despite the general acceptability of CARGs, some members cited fear of stigma, discrimination and losing respect as reasons for not joining groups particularly for those unwilling to disclose HIV status. Young people and males preferred sending relatives for facility drug pick-ups than joining a CARG. Some clients reported fear of “huroyi” (witchcraft) through someone else handling their medication as one of the reasons for not joining CARGs. Nurses expressed worry towards 6-month ART dispensing as monitoring occurs only twice yearly; patients may not seek needed care.
Conclusions: High acceptability of CARGS was shown by patients and service providers, however stigma and discrimination remain a challenge and need to be addressed at both individual and community-level. Group differentiated care may not be ideal for young people and men.

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