Table 1 Summary of strategies for differentiated models for delivery of long-term ART [13, 20]
Key objective | ART adherence clubs | CADP | CAG | CHBC | ||
|---|---|---|---|---|---|---|
Facility-based club | Community-based club | |||||
Patient perspective | Reduce cost (time + transport) | • Reduction of clinical visit • Less time spent at clinic for drug refill | • Reduction of clinical visit • Less time spent a clinic for drug refill | • Reduction of clinical visit • Less time spent at clinic for drug refill | • Reduction of clinical visit • Less time spent at clinic for drug refill | • Reduction of clinical visit • Less time spent at clinic for drug refill |
Increase peer support | At club in health facility and potentially beyond into community | At club in community and beyond | At distribution points by expert patients | At CAG meetings in community and beyond | At HBC meetings by the CHWs | |
Enhance community participation | No | Potentially | Potentially | Potentially | Potentially | |
Healthcare service perspective | Reduce workload | Â | Â | Â | Â | Â |
• Nurse | Yes | Yes | Yes | Yes | Yes | |
• Pharmacist | No | No | Yes | Yes | Yes | |
• Counsellor/CHW expert patient | No (facilitation by club) | No (facilitation by club) | No (Distribution and monitoring) | No (formation, training and supervision of CAGs) | No (formation, training and supervision of HBC) | |
Maintain/improve health outcomes | Â | Â | Â | Â | Â | |
• Adherence | Yes | Yes | Unknown | Unknown | Unknown | |
• Retention | Yes | Yes | Yes | Yes | Yes | |
Improve self-management of patient | Adherence support | Adherence support and tracing | Organisation of service for drug refill, adherence support, tracing and testing | Drug refill, adherence support, tracing and testing | Adherence support and tracing | |
Decongest facility | No | Yes | Yes | Yes | Yes | |