Adherence clubs (ACs) for people established on treatment were rolled-out in the Cape Town Metro health district of South Africa in 2011. ACs, now known as HIV Clubs, are groups of 25-30 clients established on treatment who meet for 30-60 minutes. The Club is facilitated by a lay provider who provides a brief symptom screen, referral where necessary, peer support and distribution of pre-packed antiretroviral therapy (ART) to all the members present every 2-3 months (4-6 times a year). No client folders are pulled; nor is individual adherence counselling provided. Group members have their viral load taken at one of their annual group visits and are seen individually for clinical review at their next group visit. They also have access to clinicians through the model referral mechanisms if they become unwell. Group members are allowed to send a friend or family member to collect their ART drug supply in the group. Group attendance is recorded as a client visit in the paper-based registers, which are then captured in the facility’s electronic monitoring system (EMR). Clubs are an example of a health care worker-managed group model.
Clients are seen annually for a comprehensive clinical consultation and are screened routinely for tuberculosis (TB) at each Club visit by the Club’s lay provider. In 2014, the provision of tuberculosis preventive therapy (TPT) was integrated into Clubs. Information on TPT is given to each Club, with clients screened individually for TPT eligibility by a nurse or doctor. To align the ART refill, two-monthly refills for INH and pyridoxine are prescribed. Clients are advised to report to the clinic if they experience any side-effects and are then subsequently followed up by the lay provider at the next Club visit where all Club patients are routinely screened specifically for TB symptoms and generally for any other problems; clients with any concerns are referred to and reviewed by the Club nurse. Details of TPT are integrated within the adherence club registers and the timing for stopping TPT is reviewed using the register with each routine scripting cycle.
Eligibility
Same ART regimen for 6 months, 1st or 2nd line ART, recent undetectable VL, no active TB, no condition requiring regular clinical follow up, adult (>18 years)
Building Blocks for TPT
Screening for TB
What
Verbal symptom screen
When
Every two months; for TPT catch up, whole group screened at one meeting for eligibility
Where
Club meeting space at facility
Who
Lay worker who facilitates group
Initiation of TPT
What
TPT eligibility assessment; Initiation of INH and pyridoxine; Scripting INH to align with club ART refills; TPT reflected in club register; TPT group treatment literacy (by lay club facilitator)
When
Aligned for group
Where
Club meeting space at facility
Who
Nurse or doctor
TPT refill
What
TPT group literacy; TPT follow-up assessment (TPT side-effects and/or TB symptoms); Refill of INH & pyridoxine
When
Every two months in line with ART refill (prepacked together)
Where
Club meeting space at facility
Who
Lay worker who facilitates group (six-monthly INH and ART rescripting done by nurse or doctor)
Completion of TPT
What
TB symptom assessment
TPT completion documented in M&E systems
When
After 12 months
Where
Club meeting space at facility
Who
Prescribing nurse or doctor
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 TPT integration within community-based ART distribution points in the Democratic Republic of Congo here.
Learn about TPT integration within facility fast-track in Zambia here.
