By Doreen Hove
Chido Musa* and Angela Moyo* are from Nyazura, a rural community in Manicaland province, Zimbabwe. They are living positively with HIV and share a common story of how they brought together people living with HIV and became community antiretroviral therapy (ART) refill group (CARG) leaders. When they each formed these USAid-supported groups back in 2017, they never imagined that their innovative model would be just what they needed to limit their exposure to the novel coronavirus (Covid-19).
At 46, Musa is energetic, bubbly, and full of life. She loves watching football.
“I am a huge football fan. Before the Covid-19 pandemic, I never missed a match. I went for every match over the weeakends to support my team — Nyazura — and like every football fan, would cheer them on, at the top of my voice. Right now, I miss football,” Musa says.
“With the Covid-19 pandemic, we are all staying at home. Staying at home is hard, but we have to.”
Musa has been living with HIV for more than 14 years. A natural leader, she was selected to lead a CARG — a decision that transformed her life.
“When I was introduced to the CARG model in 2017, I mobilised six other people in my community, whom I always met when getting my antiretroviral (ARV) medicines at Nyazura clinic. With time, our group membership increased to 10 people,” she says.
Through USAid’s innovative CARG model, developed under the Zimbabwe HIV Care and Treatment Project, one group member can go to the clinic and refill ARV medicines for up to 10 people living with HIV. USAid and its grantee, FHI360, found that one of the barriers to staying on treatment is juggling the logistics required to refill prescriptions, particularly for those who live in rural areas and may have to walk up to 10km to access their medications.
Before the CARGs were formed, people living with HIV often found themselves waiting for hours at crowded hospitals to get their medication.
“Sending one person to get medicines on our behalf is good for us because we have time to do our work,” Musa said.
“We are no longer crowded [together] at [the hospital] at the same time, and the process to get our medicines is much faster. With more time for our work, we are now living life like everyone else.”
For Moyo, it was all about determination.
“I discovered I was HIV positive in 2005 when I first fell sick. My child was only 13 years old. I was determined to stay alive so that I could work for my child, send her to school, and help her get a life for herself. I have been taking ARVs since,” says Moyo.
Moyo is from a village called Chakuma.
“I am an entrepreneur. I run a small sewing business. Many customers from my community bring their patterns and styles, and I sew the outfits for them,” she says.
With Covid-19, Moyo’s business has slowed. She also leads a CARG of eight members.
“The CARG gives us a space where we can support each other to take our medicines consistently and live positive lives,” Moyo says.
“We are organised. We have a book where we track whether everyone is taking their pills so that no one defaults. I am happy that each member is very responsible. When the day comes to collect their medicines, they all come on time.”
When the Covid-19 pandemic hit, CARG leaders like Musa and Moyo showed courage and compassion, braving the new crisis for their peers living with HIV.
“In anticipation of a longer lockdown, I quickly visited the clinic to collect ARVs for my members,” Moyo said.
“I handed the nurse our book, and I was so happy that they gave us six months’ supply of our ARVs.”
Her efforts, along with those of her CARG peers, vastly reduced the number of times members visited clinics, reducing potential exposure to Covid-19.
As the lockdown continued, CARG leaders and USAid-supported facilities adapted.
Having six months’ supply of their ARV medicines means each member can stay at home and avoid exposure to Covid-19 while taking their medications consistently.
Musa, Moyo and other CARG leaders also received training from USAid and information on how to protect themselves during the pandemic. They went back and trained their group members.
The CARGs model provides differentiated service delivery to people living with HIV.
“When a person living with HIV has been taking their medicines consistently and their viral load is low, they do not necessarily have to go to the hospital all the time,” said Auxilia Muchedzi, chief of party for the USAid-funded FHI360 Zimbabwe HIV Care and Treatment Project.
“The CARG model helps decongest hospitals and clinics, as it means fewer people will visit the health facilities at a time.”
People living with HIV can offer each other psychosocial support as well as reduce the out-of-pocket expenses for travel to and from the clinics/hospitals.
“The CARGs model is now more important than ever, as it vastly reduces the number of times people living with HIV visit clinics,” said Stephanie Funk, USAid/Zimbabwe mission director.
“I am proud that with USAid support, people living with HIV are receiving at least three to six months’ supply of life-saving ARVs.
“This is critical for effective client-centred care and to minimise possible exposure to Covid-19 for people living with HIV, health workers, and project staff.”
USAid supports a total of 2 631 CARGs, representing over 17 700 people living with HIV.
In Makoni, the project has about 603 CARGs with over 4 700 members.
CARGs save members time and money, reduce crowding at clinics, provide mental and emotional support, and promote awareness about Covid-19 among members.
“We are no longer afraid — we see ourselves as warriors, conquerors — we are healthy and will not stop taking our medicines,” Moyo says.
About 1,4 million people in Zimbabwe are living with HIV and the United States government is supporting over 800 000 with life-saving ARVs.
A weakened immune system can make people more vulnerable to Covid-19, hence the need to ensure that people living with HIV have more than three months’ supply of ARVs and are taking them consistently.
The US President’s Emergency Plan for Aids Relief (Pepfar) remains committed to continuing global progress towards controlling the HIV epidemic, community by community.
USAid has also positioned partners to leverage Pepfar funding to support people living with HIV and build lab capacity to support diagnostics of Covid-19.
“Our staff on the Pepfar team are on the frontlines of the HIV response in Zimbabwe,” said Funk.
“These doctors, epidemiologists, and public health specialists are also managing assistance to Covid-19 activities such as surveillance, laboratory services, case management, and infection control. Their technical expertise helps fight the pandemic.”
*Not their real names
l Doreen Hove is the development outreach and communications specialist for USAid’s mission in Zimbabwe.