MEDECINS Sans Frontiers in Zimbabwe (MSF), has launched a new system of administering Antiretroviral Therapy (ART) drugs in Mwenezi, Masvingo in a bid to increase ART adherence, amidst indications that many ART clients were now defaulting on their medications due to the long distance and inaccessibility of health facilities.
By Michael Gwarisa recently in Sovelela, Mwenezi
The new ART administering method dubbed Out of Facility Community ART Distribution (OFCAD), is an outreach strategy whereby patients no longer need to visit a health care facility to access ART but rather the ART clients community selects a certain household from which they collect their medications at any given interval.
The program is being run in seven locations in Mwenenzi namely Sovelele, Makugwe, Chipangai, Turf, Mateke and two others.
During an Editors Media Tour organised by the National Aids Council (NAC), MSF Counselor and mentor, Mr Onwell Nyekete said they had activated the new ART distribution program following revelations that 46 percent of people who had been initiated on ART before had discontinued taking their meds due to the poor road network and lack of transportation to health facilities.
“Due to lack of access to health care facilitated by distance, flooding rivers, poor road network and lack of public transport, people ended up stopping treatment.
“So we identified 46 percent loss to fallout when we were doing our order review evaluating the program. We did that before we started the outreach. Now after doing the outreach, our loss to fallout rate i below 10 percent meaning to say we have recovered all those who had stopped ART, they are now back on treatment,” said Mr Nyekete.
The nearest health facility to villagers in Sovelele is at least 50 kilometres away and the popular mode of transport in the area are donkey powered carts. Mr Nyekete added that the situation is worse during the rainy season as programmers have to go through Mberengwa to get to Sovelele, which takes at least 24 hours, as most roads leading to Sovelele will be flooded.
Mwenezi district has 22 health facilities but Chrindi, Choverere, Makugwe are somehow closer to the Sovelele community and under extreme circumstances, patients travel to Neshuro Hospital which is located 150 kilometres from Sovelele. The OFCAD program has increased ART retention amongst people living with HIV (PLHIVs).
“We also do what we call advanced diseases package, where we look at immunological status, clinical status and viralogical status as well. On the clinical and immunological status we realised that 40.5 percent of our clients who were starting ART were already in the late stage or what we call late presenters, that is stage three and stage four conditions.
“And these people will be at risk of AIDS mortality because once you are ill like that, you will die. That is why we came in, we came in to reduce mortality and morbidity due to HIV and AIDS. As of now, we realise that people are becoming healthy as compared to when we came through.”
The OFCAD program is being managed through partnerships between the Ministry of Health and Child Care (MoHCC), MSF, Baso through technical assistance from NAC. The program which kicked off two month ago has already seen 104 PLHIVs being initiated on ART.
Sister In Charge for Chirindi Clinic where OFCAD team leaders collect their ART medicines, Sister Ratidzo Jagada said the only patients they accept are those who would have been on ART for the previous six months, whose Viral load must be less than 1000 copies, should be first line regimen clients, must be a stable client, Children are not a part of the OFCAD and one that does not regularly present with opportunistic infections (OIs).
“The village health worker who will be leader of the OFCAD group only gives ART, that’s the only medicine we allow them to give out. They are not allowed to refer or transfer clients. We only allow stable clients to join the OFCAD, we don’t administer to children and the only people we give are those who will be on Tenolam E.
“This program has helped us a lot in bridging the defaulting rate. This program is not compulsory and a client is free to join an OFCAD of their choice or to continue taking from a health institution. We just give them three months’ supply of medicines and an extra one month buffer stock,” said Sister Jagada.
Meanwhile, Mrs Rineti Zhou the OFCAD 7 leader for Sovelela said the program has offered a new breadth of life to people living with HIV.
“The program came at a time when the HIV scourge was high in our area. Most elderly people were struggling to walk more than 40 km to collect their ART medicines.
“As a person living with HIV, it was also difficult for me to walk every time to collect my medicines. As of now, we all feel relieved and we are envisioning a situation whereby more people will join the program so as to increase the adherence ratio,” said Mrs Zhou.
Mr Renias Ndlovu the District Aids Coordinator (DAC) for Mwenezi said, “the OFCAD model was a good one and should be given time to grow and expand into other areas as it presents PLHIV with a lifetime opportunity to adhere to their meds without any interference.”