Table 2 Summary of the studies reviewed

Decroo et al. (2011) [53]

Community ART group—alternative ART collection by a group member in Tete Mozambique.

Stable patients on ART

(February 2008–May 2010)

N = 1384

Cohort study

1269 (97.5%) were retained in care, 83 (6%) were transferred out, 30 (2%) had died, and 2 (0.2%) were lost to follow-up.

Decroo et al. (2014) [52]

Community ART group—alternative ART collection by a group member in Tete Mozambique.

Stable patients on ART

(February 2008–December 2012)

N = 5729

Retrospective cohort

Mortality and LTFU rates among 5729 CAG members were, respectively, 2.1 and 0.1 per 100 person-years. Retention was 97.7% at 12 months, 96.0% at 24 months, 93.4% at 36 months and 91.8% at 48 months.

Dudhai & Kagee (2015)[58]

Facility-based adherence clubs—Cape Town, South Africa

Adult ‘stable’ patients are forming groups of 15–30.

N = 13

6 patients, 7 Health care workers

Descriptive qualitative design

1) The adherence club reduces the time ART users spent at the clinic.

2) Logistical problems associated with the timely and correct delivery of drugs.

3) Sense of belonging and cohesion among club patients

4) Patients become active participants in care rather than passive receivers of health care

The adherence club helps to decongest the facility

Grimsrud et al. (2015) [30]

Community-based adherence clubs—Cape Town, South Africa

Stable patients are forming groups of 25–30. Down referred to an adherence club from May 2012–December 2013.

N = 2133

Observational cohort

Over an 18-month period, 2113 patients were decentralised to one of 74 CACs (decongestion). LTFU among CAC patients was 2.6%, 3.9% and 6.2% at months 6, 9 and 12, respectively. Kaplan-Meier estimates of viral rebound were 1.4% at 6 months and1.7% at 12 months. Overall retention on ART was 97.2% at 6 months and 93.5% at 12 months.

Khabala et al. (2015) [60]

Medication Adherence Club—Nairobi, Kenya

Mixed groups of 25–35 stable hypertension, diabetes mellitus and HIV patients. August 2013–August 2014.

N = 1432

Retrospective descriptive study

From a total of 2208 consultations, for both HIV and hypertension/diabetes patients, adherence appears to be high with blood pressure checked in 99%, weight checked by 98% and blood tests ordered correctly in 98–99% of patients. 2208 consultations, 43 (2%) were referred to the regular clinic. The overall loss to follow-up was 3.5% (30).

Luque-Fernandez et al. (2013) [29]

Facility-based adherence clubs—Cape Town, South Africa

Adult ‘stable’ patients are forming groups of 15–30. November 2007–February 2011.

N = 502

Retrospective observational cohort

97% of Club patients remained in care compared with 85% of other patients. Club participation reduced loss-to-care by 57% and a viral rebound in patients who were initially suppressed by 67%.

Rasschaert et al. 2014 [27]

Community ART group—alternative ART collection by a group member in Tete Mozambique.

October 2011–May 2012

CAG patients and Stakeholders.

16 FGDs and 24 IDIs

Grounded theory

The CAG model provides cost and time savings for the patients, the certainty of ART access and mutual peer support resulting in better adherence to treatment. Patients also take more active role in their health care (self-management). Group members combine, share and develop their knowledge, experience and personal skills. At the community level, it has strengthened community action, empowered patients.

Rasschaert et al. (2014) [27]

Community ART group—alternative ART collection by a group member in Tete, Mozambique.

October 2011–May 2012

CAG patients and Stakeholders.

16 FGDs and 24 IDIs

Exploratory

qualitative

(1) The CAG model was designed to overcome patients’ barriers to ART and was built on a concept of self-management and patient empowerment to reach effective results.

(2) The daily management of the model is still strongly dependent on external resources, especially the need for a regulatory cadre to form and monitor the groups.

(3) The model is strongly embedded in the community, with patients taking a more active role in their healthcare and that of their peers.

(4) There is a growing enabling environment with political will and general acceptance to support the CAG model.

(5) Contextual factors, such as poverty, illiteracy and the weak health system, influence the community-based model and need to be addressed.

Rasschaert et al. (2014) [27]

Community ART group (CAG)—alternative ART collection by a group member in Tete, Mozambique.

October 2011–May 2012

CAG Stakeholders.

Quant data: February 2008–December 2012

Qualitative data: 16 FGDs and 24 IDIs

N = 105

Mixed-methods design

The counsellors were considered key to form and monitor the groups. The main modifications found were the progressive adaptations of the daily CAG functioning and the eligibility criteria according to the patients’ needs. The CAG leads to cost and time-saving benefits and improved treatment outcomes. The model offered a mutual adherence support and protective environment to the members. The active patient involvement in several health activities in the clinics and the community resulted in a better HIV awareness, decreased stigma, improved health seeking behaviour and better quality of care.

Rich et al. (2012) [57]

Community-based ART treatment. Group enrolment and patient support group in Rwanda.

HIV-positive adults starting community-based ART treatment between June 2005–April 2006

N = 1041

Retrospective medical record review.

Among 1041 patients who initiated community-based ART, 961 (92.3%) were retained in care, 52 (5%) died and 28 (2.7%) were lost to follow-up. Median CD4 T-cell count increase was 336 cells/mL from median190 cells/mL at initiation.

Vandendyck et al. (2015) [56]

Community ART group (CAG)—alternative ART collection by a group member in Lesotho

Six- Eight Stable patients on ART January 2007 December 2010

Qualitative Sample:

8 FGDs and 40 IDIs

N = 67

Quantitative Sample:

N = 199

Mixed-methods design

One-year retention of among patients in CAG 98.7% and those not in CAG, 90.2%. The CAG members commented that their CAG membership

1) Reduced time, effort, and money spent to get a monthly ART refill.

2) Induce peer support, which enhanced adherence, socio-economic support and empowered members to deal with stigma; and

3) Resulted in the feeling of relief and comfort.

4) Village health workers confirmed increase openness about HIV in their community

5) Clinicians reported a workload reduction

6) Community-led indicated that CAG members promoted health seeking behaviour to the community members.

Venables et al. (2016) [56]

Medication Adherence Club—Nairobi, Kenya

N = 106

10 FGDs

19 IDIs with HIV-positive patients and patients with NCDs

15 sessions of observations

Qualitative design

1) MACs reduce stigma for HIV-positive patients

2) MACs reduce waiting times and prevented unnecessary queues