Community ART groups (CAGs), Mozambique
Community ART groups (CAGs), or Grupos de Apoio à Adesão Comunitária (GAACs) in Portuguese, were first piloted in Tete province, Mozambique in 2008. This DSD for HIV treatment model was introduced to support clients who experienced challenges in accessing health facilities due to distances to health facilities and limited availability of extended ART refills. CAGs are groups of around four to ten clients, who take turns attending the health facility to collect the group members’ ART refills, reducing the number of visits to the facility made by each group member. CAG members are registered on group cards, with one copy held by the group and one kept at the health facility.
Following the success of the Tete pilot, CAGs were implemented nationally. In a study in northern Mozambiquan assessing all ART clients who were eligible to join a CAG from 2010-2015, CAG membership was found to reduce mortality by 55.1% and loss to follow-up by 84.3%. CAG membership has also been associated with significantly higher viral suppression rates amongst CAG members as compared to clients not in CAGs. Find more evidence for CAGs here.
Eligibility
More than 6 months on ART, CD4 count >200, no opportunistic infections
Building Blocks
Art refills
What
Distribution of ART refills that were pre collected from health facility
Adherence recorded on group card (pill count)
When
Monthly
Where
Community
Who
Group member
Clinical consultations
What
Clinical consultation
Lab tests
Pick up monthly ART for other CAG members
When
Six monthly
Where
Health facility
Who
Nurse/doctor
Variations
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Further information and resources
Published evidence for client-managed groups
Data from client-managed group models shows improved client outcomes with qualitative evidence supporting reduced costs and increased time savings. Editorials relating to client-managed groups, the utilization of expert clients as…
