Community-based delivery of antiretroviral therapy
Key information
- Organisation: KHANA
- Country: Cambodia
- Region: Asia and the Pacific
- Stage of innovation: Stage 3: Pilot
- Start date: 2021
- End date: 2023
- Type of innovation: Service delivery innovation: new or different way of providing a service
- Budget: 1,100,000 EUR
- Funder: Expertise France
Summary of intervention
For people living with HIV (PLHIV), frequent clinic visits for routine monitoring and to collect antiretroviral (ART) medicines are costly and take time. In Cambodia, KHANA has set up community antiretroviral therapy delivery (CAD), which has become integral to the response to HIV.
Community ART Group (CAG) leaders collect and deliver pre-packaged ART to people who are living with HIV who meet specific medical criteria (e.g. have had a stable viral load for a specific period). CAG leaders are peers living with HIV and also conduct routine outreach activities, including counselling, group education sessions, monitoring ART adherence, checking vital signs, following up on missed appointments, and referring unwell people to clinics.
The project has registered 2,057 people (of which 59% were female), 48% of them are adolescents aged between 15 and 19 years old, and 40% are from key populations, including MSM, transgender and female sex workers. KHANA has established 82 CAGs, of which half are led by women living with HIV. The project has involved 76 health care providers (27 female).
Results from the mid-term qualitative evaluation revealed that the model is relevant, viable and beneficial to PLHIV and is also relieving pressure on services at ART clinics. Local ownership at different levels appeared to be strong and encouraging.
learnings
Success factors included CAG’s empathy and compassion towards their peers, the willingness of the ART site staff to work with them, and the high level of stakeholders’ commitment.
next steps
The CAG project aims to develop, implement, and evaluate a scalable model for effective and sustainable HIV treatment adherence for PLHIV in Cambodia using a community participatory approach. This is a 36-month project – 6 months of developing the intervention, 24 months of implementation, and 6 months of impact and cost-effectiveness evaluation in 10 ART sites in the capital city and four provinces.
The effectiveness and cost-effectiveness will be evaluated after the completion of the intervention. The scale-up of the model will be considered by the national HIV programme in Cambodia.
sustainability
The model will be owned by the CAGs, people living with HIV who will remain in the group and rotate around the team to organise the pre-packing of ARVs at the ART sites. The concept of savings has been introduced and CAG’s monthly savings will be used for transportation to the ART sites. Also, the CAGs will be part of the Commune Council Development Plan, giving them the opportunity to discuss investment in HIV and ensure it is included in their local commune plans. The partnership had been assured at the technical, operational, and community level.
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