In Ndhiwa, Kenya, the community ART group (CAG) is one of the DSD for HIV treatment models offered. Four to 12 people living with HIV form a group and meet in a community setting every three months. One group member is nominated to collect ART for the whole group from the health facility every three months. Every six months, the group members attend the health facility together for their individual clinical consultations.
When CAGs were first implemented, clients had to make additional visits to the clinic for family planning and contraceptives. Contraceptive options in this setting include contraceptive implants, the three-monthly injectable and oral contraceptive pills. Intrauterine devices (IUDs) are available but are rarely taken up; the vast majority of women use the injectable.
To reduce trips to the clinic, the CAG members requested that resupplies for members needing reinjections or pills be dispensed when ART is collected. On the community CAG refill form used during the CAG meetings, members’ family planning use is part of the routine documentation. Any CAG member who requires reinjection or needs to collect oral contraception resupplies from the clinic is selected to collect ART for the group, and thus can receive their contraception at the same time. Duration of contraceptive pill refill is aligned with the ART refill (three monthly).
Eligibility
At least 12 months on ART with no opportunistic infections, undetectable viral load, 6 months of IPT completed, at least 20 years old and demonstrated good adherence in the past 6 months.
Building Blocks for contraceptive methods
IUD
What
Available but not taken up
When
Available but not taken up
Where
Available but not taken up
Who
Available but not taken up
Contraceptive implant
What
Implant information, counselling, insertion/ removal, management of side effects
When
At DSD entry
At DSD clinical visits
At facility walk in services in between visits if contraceptive need identified
Where
At same facility as ART where transition to DSD initiated/ ART collected for CAG
Who
Implant trained doctor, clinical officer, midwife or nurse
Oral pills
What
Combined and progestin only pills, information, counselling, script for pills, management of side effects
When
3 monthly
Where
Collect ART and FP script from same clinic room and pharmacy
Who
FP-trained clinical officer, midwife or nurse provides script
Sub-cutaneous 3-monthly injectable
What
Not yet available
When
Not yet available
Where
Not yet available
Who
Not yet available
Intra-muscular 3-monthly injectable
What
Injectable information, counselling, administration and management of side effects
When
3 monthly
Where
Injection given in same room as ART assessment; group member in need nominated to collect ART for others
Who
FP-trained clinical officer, midwife or nurse
Condoms
What
Male and female
Information, counselling and dispensing of condoms
When
3 monthly
Where
Dispensed at facility to group member, distributed in community
Who
Client collection or dispensed at facility by midwife, nurse or lay cadre
Further reading
Interested in in Leveraging differentiated ART delivery models for stable clients to scale up TB preventive therapy? Read more here. Also available in French and Portuguese
Learn about family planning integration within postnatal clubs in South Africa here
