When a good idea becomes good news: adherence clubs in the Free State
By Ufrieda Ho
A simple well-managed idea is not only easing pressure on the Free State health care system and making HIV-positive patients’ lives easier – it also seems to be bringing down mortality rates amongst those with multi-drug resistant tuberculosis (MDR-TB).
Médecins Sans Frontières’ HIV adherence clubs have grown, in under two years, to include 11 000 member in the Mangaung district.
The idea was to create clubs of no more than 30 stable HIV patients (those with a viral load below 40) who meet every two months for less than an hour to collect their ARVs. Is this correct? Doesn’t undetectable viral load normally mean under 50, or is there a new test?
Their medicines are pre-packed by a trained facilitator, so there’s no risk of queuing for an entire day only to be told there are no drugs or that there are too many people to be helped.
At the club meetings, patients are weighed, given TB screening and are given a general health quiz. They can discuss issues among themselves, and facilitators also have the opportunity to raise any specific matters, like a change in medicine packaging.
Members fetch their medicine and leave the clinic before the hour’s up. It means they can get on with their day with minimal disruption.
Once a year they undergo a blood test at a clinic. This test is scheduled by their club.
“It means there 11 000 people who are not clogging up the queues in clinic and hospitals. The patients are properly management and it’s proving to be a system that’s working,” says Trudie Harrison, a coordinator at MosaMaria, the public benefit organisation affiliated to the Anglican Church that manages and facilitates the adherence clubs in the district.
“The aim now is to roll out to reach 21 clinics across the province in the next three years.”
The clubs are funded by Global Fund and Right to Care. Their support has translated into the purchase of four Wendy houses erected on clinic property. These structures serve as club meetings rooms and can also be used as extra facilities by the clinic.
“At some of our facilities we do two sessions a day. Our staff is also trained and salaried. They are not volunteers on a stipend and that model has been part of what’s made the clubs work.
“It also works that the club meetings happen at the clinic or hospital and not in a facility like a church hall. This removes some of the stigma that still exists around HIV/ AIDS,” says Harrison.
MosaMaria’s success with the adherence clubs has led to them partnering with the Naledi Hospice and the Hospice Palliative Care Association of South Africa, working to manage multi-drug resistant tuberculosis (MDR-TB).
The programme is aimed at reducing the rate of defaulting among MDR-TB patients and to reduce MDR-TB mortality rates.
MosaMaria has one nurse and two caregivers on the programme. They currently visit 11 patients to give them a daily injection and other medicine.
“This programme works because before, those with MDR-TB didn’t get treatment because they didn’t want to stay in hospitals. This way, the 24-month treatment can be administered by a nurse in the patient’s own home,” says Harrison.
Harrison says it’s too early to measure the success of the programme but she says that since October 2014 they have seen the mortality rate decline. It’s significant because MDR-TB patients only have a 50/50 chance of surviving.