Differentiated Model of Care; Piloting Community Antiretroviral Group, a Novel Strategy, in North central Nigeria

Abstract

Retention in care and antiretroviral coverage in most sub-Saharan Countries, including Nigeria, is limited by factors such as long distances to clinics, long waiting time in clinics, high transportation costs, among others.  Differentiated Models of care, (DMoC) including Community Antiretroviral Group,(CAG) have shown promise in some African countries. This is being piloted at the Asokoro District Hospital, Abuja in an attempt at ensuring excellent ART coverage and Retention in care. Certain Biophysical and laboratory data were extracted from the hospital's CAG register. Questionnaires to elicit the opinion of patients and care givers were administered. Activities of the group members particularly the group leaders in the facility and communities were documented. The pilot had eighty-four clients, 62 females and 22 males. They were placed in fourteen groups, each with 6 clients. The mean age is 39.38 + 9.68. The average distance  is 12.56 km. The mean return transport cost per month is 996.4 + 183.3 Naira.

Community antiretroviral group is a differentiated model of care and an ART delivery model that applies lessons learnt from the management of other chronic diseases and community-based models, found to be beneficial.  On a clinic day, before CAG, patients of the Asokoro district hospital travelled a minimum distance of 25.12 km to-and-fro the hospital, spending hours on the way. The mean cost of this journey is 996.4 Naira. With CAG, both the travel time and travel cost, were saved, with minimal travel hazards, disruption/absenteeism to work and business. CAG is a novel strategy that will achieve the main aim of optimizing retention in care, while ensuring good outcomes. Patients stand to benefit by saving time and transport costs. Other facilities may learn from this pilot.