HIV self-management through patient groups in Mozambique

In Mozambique there are less than five doctors per 100,000 people, and 11.5 percent of the adult population are living with HIV. In rural areas, health centres are few and far between. These dire circumstances caused Médecins Sans Frontières to recognise the need to make optimal use of the scarce resources that do exist and to empower patients to provide each other with support.

In Médecins Sans Frontières’ HIV project in the Tete district in northern Mozambique, patients are divided into groups of around six people who live near each other. Each month, the group chooses one person to go to the health centre and collect the antiretroviral (ARV) refills. On return, the representative distributes the ARV drugs to the other group-members. The representative also checks that the members of the group have been taking their medication correctly, so that this information can be relayed to the health centre.

“This model has led to a reduced burden on healthcare services, as fewer patients need to queue up at the health centre to get their drugs,” explains Tom Decroo, Médecins Sans Frontières’ Medical Focal Point in Tete. “It has the potential to facilitate the scaling-up of ARV treatment - something that is desperately needed in a place like Mozambique, where only one in three who need treatment actually gets it.”

The model has also made it simpler for patients in remote areas to obtain their drugs, as they only have to pay for transport for the designated group leader, and do not need to sacrifice a day’s work to travel to the health centre. Yet another advantage is that it enables group members to support each other in overcoming problems related to the stigma associated with HIV/AIDS.

“The Community ARV Group model is good for all patients,” says Margarida Smith, a leader of one of the patient groups. “We come together and support each other. In the past, many patients didn't have enough money to pay for travel by themselves. Some stopped taking their medicine and died as a result.”