Impacts of community delivery of antiretroviral drugs in Dar es Salaam, Tanzania

Evaluation and Lessons Learned
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The success of antiretroviral therapy (ART) to treat HIV and reduce transmission rates is critically dependent on lifelong adherence. Studies have found low retention and adherence in ART care among patients, which can lead to treatment failure and resultant morbidity and mortality. These factors can also increase the risk of HIV transmission and the development of drug-resistant HIV strains.

The primary reasons for missed ART clinic visits are a lack of time, as well as costs associated with receiving treatment. The delivery of antiretroviral drugs (ARVs) at home through community health workers could overcome many of these barriers. The reduced patient load could decongest ART clinics, decrease waiting times and improve quality of care as facilitybased healthcare workers have more time available per patient.

Main findings

  • The ART community delivery scheme appears to be no worse, in terms of viral failure, than standard facility-based care. „„This delivery model for ART care experienced high uptake.
    Participants were satisfied with the scheme, and it is likely to save patients considerable time.

  • Most participants who received ART community delivery (96.3%) reported that they would like to continue with the program (rather than return to standard facility-based care), and nearly all (99.7%) said they would recommend it to other communities.

  • Decongestion of healthcare facilities and reductions in patients’ healthcare expenditures were minimal.

  • The primary patient concern was confidentiality of home visits.