Predictors and outcomes of participation in community Anti- Retroviral Therapy refill groups among people living with Human Immunodeficiency Virus, Seke District, Zimbabwe 2019.

Abstract

In 2009, Zimbabwe introduced a differentiated service delivery (DSD) model called Community ART Refill Groups (CARGs). CARGs a redesigned for up to 15 stable HIV positive clients. Its objectives are to decentralise Anti-Retroviral Therapy (ART) services, allow clients to share psychosocial support and lessen the burden of traveling to health facilities for ART refills. By December 2018, only 4.1% (1223/29644) of People Living with Human Immunodeficiency Virus(PLHIV) on ART had joined CARGs in Seke district. This study determined predictors and outcomes of participation in CARGs among PLHIV. Methods: A mixed method study comprising of a1:1 unmatched case control study, focus group discussions and records review was conducted. Simple random sampling was used to recruit participants. Data was collected through interviewer administered questionnaires, interview guides and records reviews. Epi Info7TMwas used for univariate, bivariate and logistic regression analysis. Thematic analysis was done for qualitative data. Results: Results: One hundred and fifteen case-control pairs were recruited. Having a family member participating in CARGs (aOR 2.65, CI 1.27-5.51), perceived privacy in CARGs (aOR 5.23, CI 2.44-11.2), perceived peer support in CARGs (aOR= 3.98, CI 1.90-8.30) and failing to disclose HIV status within 6 months of diagnosis (aOR= 0.43, CI 0.20-0.90) were the independent predictors of participation in CARGs. Stigma, HIV status disclosure and awareness were prominent themes on barriers to participation in CARGs. CARG members were adhering to ART (X2=4.56, p<0.05) and had less risk of acquiring sexually transmitted infections(X2=4.33, p<0.05) than non CARG members. Viral load suppression between CARG and nonCARG members was comparable (X2=2.37, p=0.12).Conclusion: This study confirms that CARGs results in higher adherence, safer sex and peer support among stable PLHIV on ART. Health care providers have a critical role to play in creating awareness of and education on the role and benefits of CARGs for PLHIV.