Community-Based ART Resulted in Excellent Retention and Can Leverage Community Empowerment in Rural Lesotho, A Mixed Method Study

Objectives: We conducted a mixed method study to evaluate the pilot of community ART groups (CAG’s) in Lesotho. Method: At the end of 2012 CAGs were piloted in Nazareth clinic, a facility in rural Lesotho. In CAG’s stable patients take turns to collect antiretroviral therapy (ART) for fellow group members. Kaplan-Meier techniques were used to estimate retention among stable patients in CAG and not in CAG. Eight focus group discussions with 40 purposively selected CAG members, nine village health workers, six community leaders and nine clinicians provided insights in how CAGs are perceived by different stakeholders. The thematic analysis approach was employed for data analysis. Results: Among 596 stable patients 199 (33%) had joined a CAG. One year retention among CAG members and patients not in CAG was 98.7% (95% CI, 94.9-99.7) and 90.2% (95% CI, 86.6-92.9) respectively. CAG members commented that membership in CAG: 1) reduced time, effort, and money spent to get a monthly ART refill; 2) induced peer support, which enhanced adherence, socio-economic support and empowered members to deal with stigma; and 3) resulted in a feeling of relief and comfort. Village health workers confirmed increased openness about HIV in their community. Community leaders added that CAG members promoted health seeking behaviour to community members. Clinicians reported a workload reduction. Conclusion: Participation in CAG impacted positively on the lives of members, not only on their access to ART, but also on their life within the community.