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Differentiated Service Delivery

Differentiated Services Delivery (DSD Models)

differentiated service delivery model

ZNNP+ embraces DSD models as outlined in the Operations Service Delivery Manual (OSDM) of the Ministry of Health and Child Care in their entirety. Besides those that are in the OSDM, ZNNP+ takes note and embraces other new DSD models that are upcoming like the OFCARD as well as the delivery of medicines through private pharmacies. The organization piloted the CARG model with the support of Global Fund New Funding Model. These were piloted in the 8 rural provinces of Zimbabwe which excluded Harare and Bulawayo. For other models ZNNP+ engages in demand creation activities and PLHIV are encouraged to engage with the service providers and be enrolled into the models that best suits them.

Community ART Refill Groups (CARGs)

Background of CARGs in Zimbabwe

Zimbabwe has made commendable progress in the provision of anti-retroviral treatment (ART) services. Further supporting the progress has been the adoption of the Community ART Refill Group model, popularly known as CARGs. These are self-formed groups of people living with HIV within the same geographical area, and led by individuals who have been consistent with their treatment and have the ability to encourage others to adhere to treatment. The model seeks to overcome the costs and challenges faced by people living with HIV in accessing treatment, especially vulnerable communities which live some distance from health centers.

The formation of CARGs is against the background of challenges with raising money for transport which had seen many people defaulting treatment. Through coming together, patients on ART have been able to counter stigma by coming together and speaking with one voice on issues of their health within their communities. The implementation of the CARG model has thus led to:

hiv & ncds
hiv & ncds
  • Increased adherence to ART
  • Reduced workload for health workers
  • De-congestion of health facilities
  • Reduced transport costs for ART clients on drug refill
  • Enhanced individual and community resilience
  • Reduced stigma and discrimination both internal and enacted
  • Enhanced health facility and community partnerships

What is CARG?

A CARG is a self-forming group of HIV positive persons currently on ARVs who live in the same community, organised in groups and have a shared understanding, whose members take turns to collect ARVs at the health facility and distribute them among other group members in the community. Such groups normally have membership that does not exceed 12, and are free and willing to disclose their status to each other. The groups support each other with ART refill by collecting on behalf of other group members, but the members have to visit the clinic for their clinical visits and monitoring of blood tests as per protocol. Each group nominates a group representative who assists in coordinating the group and keeps important dates for each member.

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CARGs and Differentiated Care

CARGS provide an opportunity for Differentiated Care for group members. Differentiated Care describes the continuum of adaptations that can simplify HIV services including ART delivery. Differentiated Care is important to support provision of quality, patient-centred care reflecting the preferences and expectations of PLHIV, while reducing unnecessary burdens on the health system. By providing differentiated, care the health system can refocus resources to those most in need. When implemented well, differentiated care will be an integral part of reaching the ambitious 90-90-90 targets


Goals of CARGS

  • To reduce the workload of the existing health workers in the health facilities. Instead of attending to 10 ART clients at one particular moment the nurse only attends to 1 person who is collecting treatment for everyone else.
  • To improve long-term retention in care by reducing access barriers by enhancing the role of the ART client in the management of his/her condition.

Why CARG?

With CARG members taking turns to refill each other’s ART, CARGS help in cutting the key barriers to accessing treatment which include, but are not limited to the following:

  • Long distances from home the health facilities
  • High cost of and in some instances non-availability of transport
  • Defaulting due to weak community support systems and peer-peer PSS
  • Competing needs and activities i.e. informal trade, peasant farming and farm labourers.

Who is Eligible to Join CARG

  • Any individual member should be willing to disclose their HIV status to other members
  • The person has to be living with HIV and also has to be willing to participate in the CARG.
  • The individual should not be having any opportunistic infections
  • Should have been on ART for at least six months prior to joining the CARG
  • The individual should be having an undetectable Viral Load.
  • Should not be on treatment for TB or any other OI.
  • Should have attained at least 15 years of age
  • The individual should not be a pregnant or lactating woman.
  • All members and prospective ones should be accessing their ARVs at the same health facility with other members
  • Live in the same geographical area as the other members