The Sunday Mail
Sharon Kavhu
Zimbabwe has made strides in anti-retroviral treatment (ART) service provision and, among other interventions, has adopted the Community ART Refill Group model, popularly known as CARGs. CARGs are self-formed groups of people living with HIV within the same geographical area. The groups are led by individuals who have been consistent with their treatment and have the ability to encourage others to adhere to treatment.
Adopted from Mozambique, the model seeks to overcome the costs and challenges faced by people living with HIV in accessing treatment, especially vulnerable communities which live some distance from health centres.
“When I tested HIV-positive five years ago, the challenge was accessing the drugs because I could not afford the $2 for transport to and fro Chingombe Clinic,” said Sekuru Ephraim Mukwashe (65), a CARG focal person for Marife Village under Chief Chingombe Ruzire in Gutu.
The challenges with raising money for transport saw many people defaulting treatment. The other reason why the groupings have found favour with the communities is the ability to counter stigma. He added that some individuals feared to be stigmatised while waiting in long queues for their ART drugs.
Sekuru Mukwashe’s group has 22 members and he said the model has brought positive changes in ART access in his community.
“My village is some 27 kilometres away from the clinic and it was difficult for all the 22 individuals to come and collect their medication, so when this idea of having one person collecting on behalf of others was introduced, it reduced the transport burden on us.
“Instead of pumping out $44 from our community for each and every individual to collect drugs, the group members can take turns to contribute $2 for me, as the focal person, to collect the drugs. Sometimes they also contribute food for me to eat while I travel to and fro.”
He said whenever he does the drug collection, he meets up with other CARG’s focal persons from different villages and share ideas on how to encourage group members on adherence.
“Besides collecting and distributing drugs for my fellow ART patients, we regularly meet to share our experiences, counsel each other and encourage each other not to be discouraged by those not living with HIV,” added Sekuru Mukwashe.
He continued: “From our regular meetings, it has emerged that many elderly people are facing challenges in accessing decent food which is key for any person on ART. Due to old age, these people work the soil and some of them have since been left by their children, who have gone to work.”
To help solve the problems, he said the focal persons decided to encourage their group members to do projects such as gardening in groups to ensure that every member has a healthy diet.
“As for some, they fail to get their CD4 count tested because there will be no-one to take them to the clinic. Unlike younger people who can walk long distances on their own, the elderly in my community cannot do that. It is a challenge for them to walk the long distances to the nearest clinic.”
The CARGs model was initiated in Gutu last year August as a trial, with the district copying the model from Buhera district.
“Last year, people were still adapting to the new models, some were shy to join the groups or meet up with their fellow group members,” explained Sister Shumirai Gotami. “Beginning of this year, people adjusted because they realised the role of CARGs in HIV treatment and moral support. The group members started to increase on a monthly basis.”
Because focal persons are the ones who collect ART drugs, those who would have been initiated on treatment need regular assessment. As such, when it is time for their review, they do the collection of drugs for the group and the focal person stays behind.
Sister Gotami added: “CARGs are made up of young, middle-aged and elderly. However, children living with HIV below 10 years are not allowed to be part of the groups because they need counselling and constant monitoring from the clinic as well as regular CD4 counts. The same applies to mothers on option B plus.”
National Aids Council chief executive officer, Mr Tapiwa Magure, applauded the success of CARGS in Zimbabwe saying the concept should be spread to all remote areas countrywide.
“The implementation of the models in Zimbabwe has led to increased adherence to ART, has reduced work loads and congestion at clinics, minimised transport costs for patients, enhanced individual and community resilience, reduced stigma and enhanced health clinic and community partnerships,” Magure said.
The model of CARGs originated in Tete province, Mozambique, as a trial between February 2008 and December 2011. In 2009, the lessons learnt were launched in semi-urban settings to decrease time spent in the clinics.
