Join the club

It’s 7.30am on a Tuesday and Tshepo Pita and Lehlohonolo Mafabatho are watching the clock. The minutes count because they’re on a tight schedule. Within an hour they want the 30 HIV patients seated in front of them to have been helped, given their meds and to be on their way even before the workday has properly started.

Tshepo and Lehlohonolo are facilitators, part of Mosamaria’s ART Adherence Clubs programme at the MUCPP Clinic in Mangaung outside of Bloemfontein. The NGO has been involved with treatment literacy training with community- based facilitators since 2009. This year they’ve introduced ART Adherence Clubs as part of their programme. The club model of treatment is paying off with significant successes and wins all round for patients, healthcare workers and even government.

The ART Adherence Clubs programme was developed by Médecins Sans Frontières (MSF) as a response to the high rate of ART defaulting, often because hospital queues are too long. They piloted the first clubs in the Western Cape with the TAC and are now introducing them throughout the country. The clubs create a diverted treatment channel for clinically stable HIV-positive patients. Mosamaria facilitators are put through special training and are paid through donor funds. It means they are paid a proper salary and have been adequately supported to perform their jobs with commitment and a positive attitude.

The facilitators help reduce the day-to-day patient load for clinic sisters. And, because the clubs work efficiently, they also act as an incentive for people to take greater personal responsibility for their drug adherence so that they can join or stay in a club. Treatment defaulters and those who don’t attend meetings regularly are returned to the regular, long queues.

Currently Mosamaria has 270 adherence clubs in the Mangaung Metro, at 10 different clinics, with nearly 5 000 members. Nomathemba Nkabi, the project manager of the ART Adherence Clubs, says: ‘The clubs are never bigger than about 30 people; this is the model that works best.

The patients arrive at the club where they will spend a few minutes talking about general issues and problems they are experiencing. They are a small enough group to share information and to support each other as peers. They also come to know each other so they’ll notice if someone has missed one or two meetings,’ she says.

She adds: ‘Before, we saw that people would just not come to pick up their medicines because of the long queues, especially if they had jobs. If you have to choose between getting your medicine or keeping a job, you might also not stand in the queue.’

Patients at the MUCPP Clinic meet inside a boardroom, away from the general waiting area that, by 7.30am, is jam-packed. The patients take their turn being weighed, answering a general health questionnaire and a TB symptom screening questionnaire. Annually, the club patients must undergo a blood test to establish that their CD4 count and viral load are still being managed properly, and they must meet with a clinician. The facilitators refer patients back to clinics and hospitals if a patient’s data indicates the need for medical intervention.

‘It’s good for the patients because they come here, they don’t have to wait like other patients, they know we check that everything is okay with them, they get their medicines and they go,’ says Tshepo, who walks into the room with a box of labelled and sealed brown bags that he and Lehlohonolo have collected from the clinic dispensary and pre-packed for each patient.

There are three brown bags left in the box once patients have received their meds. Tshepo says: ‘The one lady has arranged with me to pick it up later and I will phone the other two patients and see what went wrong this morning.’
He says it’s a two-way relationship and facilitators and patients come to communicate and understand each other better in the club set-up. Facilitators know when someone is defaulting and when someone has a legitimate reason for not being able to attend.

Nomathemba says they are working towards an optimal club model where patients will only need to attend meetings once every two months and where patients’ from the same club can have their blood tests done at the same time each year.

‘There are a few things here and there that we are still working out, but this really is a success story and we are hoping to expand this into the community and also to start afternoon clubs,’ she says.

It’s 8.40am and the last patient in the club walks out the door. Tshepo and Lehlohonolo can put it down to a good start to the day!