Improving Adherence & Retention: Community Adherence and Support Groups (CASGs) in Mozambique

Description/Activities:  CASGs are groups of stable patients on ART who take turns attending the facility for a clinical assessment and tests, whilst collecting drugs for themselves and the other members of the group. The CASG provides a means of accessing ART for the group members and a source of social support, both of which are intended to reduce LTFU. CASGs can reduce the workload of overburdened healthcare workers by decreasing the number of patients individually attending the clinics.

What Makes the Intervention Unique/Different:   This comprehensive intervention brings convenience to the client by bringing services closer to them, rather than asking them to go to the clinic to pick up their medicines.  It also addresses the challenges of loss to follow-up by providing social support and reduce the congestion in the healthcare system by providing differentiated service delivery for stable patients.

Impact Data: CASGs were originally piloted by Médecins Sans Frontières (MSF) in 12 health facilities in Tete province, beginning in 2008. A retrospective analysis of 5,729 adults who joined CASGs between February 2008 and December 2012 in Tete, showed rates of retention on ART of 98% at 12 months, 96% at 24 months, and 93% at 36 months, and 92% at 48 months (Decroo, 2014). This is substantially higher than national retention, which was around 70% at 12 months in 2012 (in sites with electronic patient tracking systems).