Bringing AIDS medication closer to the people helps them not to default on their treatment. Presentations made by the NGO Médecins sans frontières (MSF) on the first day of ICASA underlined the effectiveness of programs that dispense antiretroviral treatment (ART) through groups in the community.

Relying heavily on training and on peer support, the programs aim to decentralize the distribution of ART. They circumvent problems that people living with HIV face to pick up their medication: many must skip an entire day of work to travel long distances and wait in queues at the hospital. And, in so doing, the programs cut back drastically on lost-to-follow-up rates, that is on people who stop taking their medication.

Kelly Michelo SJ, coordinator of the home-based care project of Chikuni Parish in rural Zambia, was enthusiastic about what he heard. “The focus was mainly on how the community can participate in the delivery of care. I was impressed by the many attempts from different countries to bring healthcare, in terms of ART, to where people are. This is not happening in my country,” said Fr Kelly.

For Fr Kelly, one of the main selling points is that it targets the person living with HIV: “It is about the individual needing ART, not about the institution that is failing to deliver ART. We are looking at the person and asking how we can make it easier for him or her to access to ART.”

He continued: “Pre-packed ARVs are prepared and distributed in the groups in the community so people don’t need to go to a centralized facility. In South Africa, they call it group ART. In Mozambique, they have community ART groups. In Zimbabwe, people go to the health clinics because there is a good network close to the people.”

Learning from the best practices of others is one reason why attending conferences like ICASA is useful. “We have to see what works and implement it. This solution focuses on one of the problems we have, goes against the problem of lack of infrastructure and can be adapted to the context.”

The model proposed by MSF is intended for people who have been on ART for a while and relies on building capacity among lay workers, shifting onto them the task of dispensing ART while keeping clinical follow-ups in the hands of medical and nursing staff.

In another session focused on delivery of HIV care in “fragile” settings, MSF said a decentralised model would improve access to ART in Democratic Republic of Congo (DRC), a country with only 26% ART coverage. Since HIV treatment is embedded in weak or inaccessible health systems in DRC, effective strategies would include decentralisation of follow-up to health centres, peer support, and ART distribution points run by lay workers and local patient associations.