1. Ministry of Health, Mozambique
gaAc strategy grupos de apoio a adesÃo comunitÁria Community adherence SuPPORT groups
Ministry of Health, Mozambique
MSF-OCB, Mozambique
Rome, 17th of July 2011

2. Mozambique HIV Prevalence: 11,5% (INSIDA 2009)
30% Population without access to health (PES,2007)
1 in 5 HFs has ART (245 Total ART HFs)
Need for 7 X more HRH as compared to minimal WHO recommendations ( 2010)
30 % ART coverage (WHO, end 2009)
~ 50 % LTFU ART at 3 years (CDC, not published)
Tete Province: April 2009, Partner initiative
Average time in GAAC: 13,2 months
3.530 members formed 788 GAACs

3. Strategy
GAAC (Community Adherence Support Groups) A model of community-based ART distribution and adherence monitoring by self-forming groups of patients on ART
Primary Objective
To improve retention in care of patients on ART through increasing patient involvement
Secondary Objectives
To improve access, retention and adherence of patients on ART.
To enhance the quality of the services and follow-up of patients at the HF.
To establish a system of early surveillance to triage medical conditions and situations related to LTFU.
To reduce the number of clinical appointments and the workload at the HF.
To reinforce the psychosocial support among ART and pre-ART patients.
To strengthen the link between the HF and the community.

4. 3 2 1 Strategy Health Facility Home January A B C D E Feb Mar Apr May
Member 1 goes home while members 2, 3, 4, 5 and 6 conduct GAAC trips to HF during the following five months
GAAC in the community
Feb
Mar
Apr
May
Jun
Home 2
Member 1 returns to community and distributes ARVs to other 5 GAAC members
January 1
Reception
Consultation
Pharmacy
Laboratory
Counselor A B C D E
Health Facility
GAAC member 1 goes to HF every six months for clinical consultation, psychosocial counseling, lab tests and to pick up monthly GAAC ARVs

6. National Pilot: Methods
Pilot HF selection
3 Health Facilities in each province selected – 1 health facility from each of three patient volume categories:
Each health facility required to provide a minimum package of services
ART program for more than 6 months
2 staff (clinician, nurse)
CD4 testing
TB services

7. National Pilot: Methods
Patient Inclusion Criteria
On ART for at least 6 months, good adherence
Age ≥ 15 years OR children on adult ART dosage
CD4 count ≥ 200 cel/ul and clinically stable
Interest in involvement in GAAC

8. National Pilot: Methods
Criteria for Group Formation
2- 6 members
Group is established according to social or cultural affinities related to location, employment or other kind of relationship
Each group will be formed by members that selects a Focal Point responsible for some of the main activities of the group
Group rotation

9. National Pilot: Roles 1. Tasks of GAAC Focal Point (within each group)
Coordination with the HF
Monitor & report adherence to the treatment of each group member
Monthly meetings with his group (including one the day before going to the HF)
Defaulter tracing
Remind group members to go to the HF every 6 months
Refer patients whose condition requires medical attention
Stimulate the group to create a fund to support travel to the HF

10. National Pilot: Roles 2. Tasks of GAAC Members
Be representative of the group every 6 months for:
Pick up ARVs & distribute to rest of the group
Report adherence and health status of group members
Medical appointment every 6 months
Support group members for adherence to treatment
Refer patients whose condition requires medical attention
Home visits
Conduct educational sessions within community (HIV prevention, stigma)

11. National Pilot: Roles 3. Tasks of GAAC Focal Point (nurse) at the HF
Sensitize patients on GAAC
Clinically assess for eligibility for GAAC
Coordination with GAACs
Train the focal points and members of the GAACs on HIV/AIDS, Ois, CD4, reporting and other aspects of the management group.
Monthly follow up and monitoring the adherence on the GAAC
Monitor and follow up patients with low CD4 counts, poor adherence, anemia and other aspects relating to ART.
File management of GAACs
Provide M&E, IEC materials to the focal point

12. National Pilot: M&E Proposed M&E Tools
ARVs Control Register: To register monthly patient pill-counts and report warnings of potential OIs (filled out in the GAAC community)
GAAC Register Book: To register and follow up information about the group members (including basic demographic and treatment follow-up information)
GAAC Monthly Report: To track GAAC expansion and trends in GAAC patient retention at the HF, district, provincial and national level

13. Obrigada !!

14. Thank you!