Distribution of Antiretroviral Treatment Through Self-Forming Groups of Patients in Tete Province, Mozambique
Distribution of Antiretroviral Treatment Through Self-Forming Groups of Patients in Tete Province, Mozambique
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DOI：
10.1097/qai.0b013e3182055138
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发表时间：
2011-02-01
影响因子：
3.6
通讯作者：
Ford, Nathan
中科院分区：
文献类型：
--
作者：
Decroo, Tom;Telfer, Barbara;Ford, Nathan
背景：随着抗逆转录病毒治疗人群的不断扩大，确保患者长期保留是一个越来越重要的问题。再加上能力和人力资源的限制，人们开始考虑采用临床外模式来提供抗逆转录病毒治疗（ART）。 2008年，无国界医生组织和省当局在莫桑比克太特省启动了社区团体ART分发和依从性监测的模式。 计划方法：向接受ART稳定6个月的患者通报社区ART小组模式并邀请他们组成小组。小组成员有 4 个关键职能：促进每月向社区中的其他小组成员分发 ART、提供依从性和社会支持、监测结果并确保每个小组成员至少每 6 个月接受一次临床咨询。小组成员轮流到卫生中心就诊，每个小组成员每 6 个月与卫生服务机构接触一次。 结果：2008 年 2 月至 2010 年 5 月期间，1384 名成员加入了 291 个小组。组内中位随访时间为 12.9 个月 (IQR 8.5-14.1)。在此期间，83 名患者 (6%) 被转出，在仍在社区小组的 1301 名患者中，1269 名患者 (97.5%) 仍在接受护理，30 名患者 (2%) 死亡，2 名患者 (0.2%) 失访。 讨论：社区 ART 小组模式是由患者发起的，旨在改善可及性、患者保留率和缓解医疗服务拥挤。就死亡率和护理保留率而言，早期结果非常令人满意，为此类临床外方法提供了支持。
Background: As antiretroviral treatment cohorts continue to expand, ensuring patient retention over time is an increasingly important concern. This, together with capacity and human resource constraints, has led to the consideration of out-of-clinic models for the delivery of antiretroviral therapy (ART). In 2008, Medecins Sans Frontieres and the Provincial authorities launched a model of ART distribution and adherence monitoring by community groups in Tete Province, Mozambique.Programme Approach: Patients who were stable on ART for 6 months were informed about the community ART group model and invited to form groups. Group members had 4 key functions: facilitate monthly ART distribution to other group members in the community, provide adherence and social support, monitor outcomes, and ensure each group member undergoes a clinical consultation at least once every 6 months. Group members visit the health centre on a rotational basis, such that each group member has contact with the health service every 6 months.Results: Between February 2008 and May 2010, 1384 members were enrolled into 291 groups. Median follow-up time within a group was 12.9 months (IQR 8.5-14.1). During this time, 83 (6%) were transferred out, and of the 1301 patients still in community groups, 1269 (97.5%) were remaining in care, 30 (2%) had died, and 2 (0.2%) were lost to follow-up.Discussion: The Community ART Group model was initiated by patients to improve access, patient retention, and decongest health services. Early outcomes are highly satisfactory in terms of mortality and retention in care, lending support to such out-of-clinic approaches.