Journal of Reproductive Health, Gender, and HIV in Africa | 07 April 2005
Evaluating the Impact of a Community-Based Antiretroviral Therapy Distribution Model on Viral Suppression in Hard-to-Reach Island Communities of Lake Malawi: A Qualitative Study
L, o, r, r, a, i, n, e, R, o, b, e, r, t, s, ,, G, r, a, c, e, B, a, n, d, a, ,, C, h, i, k, o, n, d, i, M, w, a, l, e
Abstract
In sub-Saharan Africa, hard-to-reach populations, including island communities on Lake Malawi, face substantial barriers to consistent antiretroviral therapy (ART) access, which undermines viral suppression. Centralised, clinic-based models are frequently impractical in such settings. This qualitative study aimed to evaluate the impact of a community-based ART distribution model, led by village health teams (VHTs), on viral suppression among people living with HIV in these isolated island communities. The study employed in-depth interviews and focus group discussions. Participants included people living with HIV enrolled in the community distribution model, VHT members, and healthcare workers. Data were analysed using thematic analysis. The model was perceived to improve ART adherence and viral suppression substantially. A key theme was the alleviation of travel burdens, with participants reporting fewer missed doses due to inaccessible clinics. Persistent challenges included occasional drug stock-outs and concerns regarding confidentiality within small, close-knit communities. The VHT-led community ART distribution model is a feasible and acceptable strategy to enhance treatment access and outcomes in isolated island settings. It mitigates key logistical barriers but requires reinforced systems to ensure sustainability. Programmes should consider scaling up this model to other hard-to-reach areas, accompanied by investment in reliable medication supply chains. VHT training should be enhanced, incorporating specific modules on maintaining client confidentiality. HIV, antiretroviral therapy, community health workers, viral suppression, qualitative research, Malawi, islands This study provides qualitative evidence on implementing a community-based ART model in a unique hard-to-reach island setting, offering practical insights for policymakers aiming to achieve viral suppression targets in similar contexts.