Catherine Murombedzi HIV Walk
People living with HIV in Matizha Village, Gutu, find it difficult getting to the nearest clinic. The closest clinic is 60 km away for some community members in the area. The roads are in a deplorable state that small vehicles cannot traverse.
Only all-terrain vehicles and lorries can pass through the area as kombis and buses have ceased to service the area.
The withdrawal of bus services has left people unable to travel long distances and for some people living with HIV this means defaulting on treatment when they fail to travel for refills.
Faced with such a challenge the community with technical help from Medecins Sans Frontiers (MSF) and monitoring by Batanai HIV/AIDS Support Organisation (BHASO) sat down and came up with a concept card.
In terms of the Community Adherence Refill Support Group (CARGS) 10 people living in the same geographical area come together and form a group.
The group meets offering support and treatment adherence.
They pool resources and dispatch one person sent to the centre to collect ARVs on behalf of the group.
National ART monitoring team spokesperson Mr Stanley Takaona of Zimbabwe HIV/AIDS Activists Union (ZHAAU) outlined how the scheme works.
“On our national monitoring tours nationwide we have come across areas where we have had to complete the journey on foot.
“Even 4×4 vehicles fail to traverse these sections as there are badly damaged roads where even bridges have been washed away.
“Under such circumstances people living with HIV have had difficulty in getting to the nearest centres to get resupplies.
“Even the outreach teams by the Ministry of Health and Child Care and most of them by MSF have had areas they have failed to reach.
“It is in such communities like Matizha in Gutu where ART clients have to travel 40 to 60km to get resupplies that challenges were experienced,” said Mr Takaona.
“With technical expertise from the MSF people who were already in support groups came together to form CARGS.
“This resulted in 10 clients selecting a focal person.
For one to qualify one ought to have been on ART for six months or more and be on first line medication.
“They also needed not be on TB treatment and have no other opportunistic infections like gonorrhoea and syphilis,” said Mr Takaona.
Mr Takaona explained that one continued to have the standard ART card at the clinic but they had information captured in a folder according to their CARGS group.
The CARGS group number was marked on the standard ART card.
At the clinic a refill form was completed and retained in the clinic for filling in the CARGS folder.
“CARGS group members meet a day before picking up drugs. They pool up resources and even if one does not have money they still do not miss out.
They select a representative who the next day goes to the clinic on behalf of the group.
“At the clinic the nurse pulls out and fills the CARGS refill form and standard ART card. T
“The appointment diary is updated and group medicine is dispensed. The representative then appends his or her signature and takes the medicine back home.
“The next day members sign that they have collected their ARVs from the collector,” said Mr Takaona.
Mr Takaona applauded this community initiative as it has seen less and less people defaulting in the areas where it has been piloted.
“In Gutu and Shurugwi, ART clients faced difficulties as they had no reliable means of transport.
“The areas are hard to reach and with the implementing of the CARGS there have been no defaulters in the groups. This saves time as clients now have enough time to work in their fields, they only need to pool resources and even when one contributed R2 or nothing they still had their medication brought. This is like bringing the service to one’s home which is convenient,” said Mr Takaona.
There have been fears that the ARVs could be abused but this was dispelled by Mr Takaona who said that BHASO in Gutu and Shurugwi monitors that there is no misuse.
“BHASO is the monitoring partner on the ground and as you know BHASO is made up of people living with HIV or affected in a way by the pandemic. So volunteers from BHASO cover the ground work in checking each CARGS and they have not reported any adverse use,” said Mr Takaona.
In Gutu five groups are now functional in the CARGS project.
These being Hupenyu-Hutsva, Kushinga A and B, Kuwadzana A and B, all from Matizha, as the pilots CARGS venture by MSF.
Mrs Takura Zhavahera from Gutu spoke well of the programme as it now allows her time to work at home and only visits the clinic when she is not feeling well.
“I am generally in good health and used to visit Matizha Clinic to collect ARVs after every three months.
“I no longer do that because I am now a member of the CARGS and only one person especially the young collect medicine on behalf of the group. We also pool resources when one of us is not feeling well and needs to travel to the clinic.
“So in our group we are ten and have a focal person.
“Everyone is free to collect on behalf of the group but usually it’s the young people who have the energy to travel that do so.
“We meet at the collector’s homestead the next day and sign on the main card that we have collected our ARVs,” said Mrs Zvavahera.
Mr Takaona said he witnessed less congestion at the clinic which had this programme as the nurses were not overwhelmed and even the pharmacies welcomed the programme.
“One pharmacist we talked to during the community monitoring outreach where the CARGS is in place said they no longer had long winding lines of people collecting medicines and hoped other communities took a cue from the CARGS project.
The nurses were also happy with the programme as they attended to one client as opposed to ten who were represented by the collector,” he added.
Distance had been a barrier to accessing ART and with the CARGS initiative, defaulting could be a thing of the past and lead to more healthier lifestyles for the villagers..