“I don’t know when he will be back”: life-changing events challenge the community ART Group model– a qualitative research study, Tete, Mozambique

Abstract Background Since 2008 in Mozambique, patients stable on antiretroviral therapy (ART) can join Community ART Groups (CAG), peer groups in which members are involved in adherence support and community ART delivery. More than 10 years after the implementation of the first CAGs, we study how ch...

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Autores principales:	Ivan Alejandro Pulido Tarquino, Emilie Venables, Rajá Reis Simone, Jose M. de Amaral Fidelis, Tom Decroo
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	HIV Antiretroviral therapy Community participation Peer support Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/9fc0965a7c19429881b04961625803b7
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spelling	oai:doaj.org-article:9fc0965a7c19429881b04961625803b72021-11-08T10:43:56Z“I don’t know when he will be back”: life-changing events challenge the community ART Group model– a qualitative research study, Tete, Mozambique10.1186/s12889-021-12087-81471-2458https://doaj.org/article/9fc0965a7c19429881b04961625803b72021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-12087-8https://doaj.org/toc/1471-2458Abstract Background Since 2008 in Mozambique, patients stable on antiretroviral therapy (ART) can join Community ART Groups (CAG), peer groups in which members are involved in adherence support and community ART delivery. More than 10 years after the implementation of the first CAGs, we study how changes in circumstance and daily life events of CAG members have affected the CAG dynamic. Methods A qualitative study using individual in-depth interviews (27) and focus group discussions (8) with CAG members and health care providers was carried out in Tete province, rural Mozambique. Purposive sampling was used to select participants. Data were transcribed and translated, and manual thematic analysis carried out to identify codes, which were then categorized in sub-themes and themes. Results Data were collected from 61 CAG members and 18 health-care providers in 2017. The CAG dynamic was affected by life events and changing circumstances including a loss of geographical proximity or a change in social relationships. Family CAGs facilitated reporting and ART distribution, but conflict between CAG members meant some CAGs ceased to function. In some CAGs, the dynamic changed as pill counts were not carried out, members met less frequently or stopped meeting entirely. Some members did not collect ART at the facility when it was their turn, and others stopped taking ART completely. Health care providers were reported to push people living with HIV to join CAGs, instead of allowing voluntary participation. Some CAGs responded to adherence challenges by strengthening peer support through counselling and observed pill intake. Health-care providers agreed that strengthening CAG rules and membership criteria could help to overcome the identified problems. Conclusions Changing life circumstances, changes in relationships and a lack of participation by CAG members altered the CAG dynamic, which sometimes affected adherence. Some CAGs responded to challenges by intensifying peer support, including to those diagnosed with virological failure. To ensure flexible implementation and modification of CAGs to the inevitable changes in life circumstances of its members, feedback mechanisms should be implemented between CAG members and the health-care providers.Ivan Alejandro Pulido TarquinoEmilie VenablesRajá Reis SimoneJose M. de Amaral FidelisTom DecrooBMCarticleHIVAntiretroviral therapyCommunity participationPeer supportPublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	HIV Antiretroviral therapy Community participation Peer support Public aspects of medicine RA1-1270
spellingShingle	HIV Antiretroviral therapy Community participation Peer support Public aspects of medicine RA1-1270 Ivan Alejandro Pulido Tarquino Emilie Venables Rajá Reis Simone Jose M. de Amaral Fidelis Tom Decroo “I don’t know when he will be back”: life-changing events challenge the community ART Group model– a qualitative research study, Tete, Mozambique
description	Abstract Background Since 2008 in Mozambique, patients stable on antiretroviral therapy (ART) can join Community ART Groups (CAG), peer groups in which members are involved in adherence support and community ART delivery. More than 10 years after the implementation of the first CAGs, we study how changes in circumstance and daily life events of CAG members have affected the CAG dynamic. Methods A qualitative study using individual in-depth interviews (27) and focus group discussions (8) with CAG members and health care providers was carried out in Tete province, rural Mozambique. Purposive sampling was used to select participants. Data were transcribed and translated, and manual thematic analysis carried out to identify codes, which were then categorized in sub-themes and themes. Results Data were collected from 61 CAG members and 18 health-care providers in 2017. The CAG dynamic was affected by life events and changing circumstances including a loss of geographical proximity or a change in social relationships. Family CAGs facilitated reporting and ART distribution, but conflict between CAG members meant some CAGs ceased to function. In some CAGs, the dynamic changed as pill counts were not carried out, members met less frequently or stopped meeting entirely. Some members did not collect ART at the facility when it was their turn, and others stopped taking ART completely. Health care providers were reported to push people living with HIV to join CAGs, instead of allowing voluntary participation. Some CAGs responded to adherence challenges by strengthening peer support through counselling and observed pill intake. Health-care providers agreed that strengthening CAG rules and membership criteria could help to overcome the identified problems. Conclusions Changing life circumstances, changes in relationships and a lack of participation by CAG members altered the CAG dynamic, which sometimes affected adherence. Some CAGs responded to challenges by intensifying peer support, including to those diagnosed with virological failure. To ensure flexible implementation and modification of CAGs to the inevitable changes in life circumstances of its members, feedback mechanisms should be implemented between CAG members and the health-care providers.
format	article
author	Ivan Alejandro Pulido Tarquino Emilie Venables Rajá Reis Simone Jose M. de Amaral Fidelis Tom Decroo
author_facet	Ivan Alejandro Pulido Tarquino Emilie Venables Rajá Reis Simone Jose M. de Amaral Fidelis Tom Decroo
author_sort	Ivan Alejandro Pulido Tarquino
title	“I don’t know when he will be back”: life-changing events challenge the community ART Group model– a qualitative research study, Tete, Mozambique
title_short	“I don’t know when he will be back”: life-changing events challenge the community ART Group model– a qualitative research study, Tete, Mozambique
title_full	“I don’t know when he will be back”: life-changing events challenge the community ART Group model– a qualitative research study, Tete, Mozambique
title_fullStr	“I don’t know when he will be back”: life-changing events challenge the community ART Group model– a qualitative research study, Tete, Mozambique
title_full_unstemmed	“I don’t know when he will be back”: life-changing events challenge the community ART Group model– a qualitative research study, Tete, Mozambique
title_sort	“i don’t know when he will be back”: life-changing events challenge the community art group model– a qualitative research study, tete, mozambique
publisher	BMC
publishDate	2021
url	https://doaj.org/article/9fc0965a7c19429881b04961625803b7
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“I don’t know when he will be back”: life-changing events challenge the community ART Group model– a qualitative research study, Tete, Mozambique

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