HIV self-management in Mozambique through patient groups reduces burden on over-stretched healthcare services

© Niklas Bergstrand - A patient group leader is making a home visit to one of the members of her group. During every visit, she makes sure that the patients in the group are taking their drugs correctly and that their health is not deteriorating.

In Mozambique, there are fewer 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 MSF 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 MSF’s 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 their 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,” explained Tom Decroo, MSF’s 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,” said 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.”