Male Engagement in Community Antiretroviral Refill Groups

Exploring Barriers and Facilitators to Differentiated Service Delivery in Zimbabwe

Zimbabwe has a very high HIV disease burden, and more than 1,400 health facilities providing ART, but the majority of patients are concentrated in just a few of these clinics and hospitals, creating overcrowding and long wait times. In response, Zimbabwe’s Ministry of Health and Child Care (MOHCC) and its implementing partners introduced a model of differentiated service delivery called Community ART Refill Groups (CARGs), designed for stable patients who are doing well on treatment. They are comprised of up to 15 people on antiretroviral therapy (ART), who meet in the community to provide mutual psychosocial support and to share the burden of traveling to health facilities to pick up ART refills.

Because of their advantages to individuals and the health systems, CARGs are continuously being formed. One barrier to expanded coverage of CARGs among stable patients is that, despite the fact that men living with HIV constitute 41.3 percent of ART patients in Zimbabwe, male participation in CARGs appears to be low.

To explore this important issue, CQUIN conducted a small mixed-methods study, including a review of existing programmatic documents as well as in-depth interviews and focus group discussions. Interviews were used to explore the views of policy makers, implementers, health providers, and other key stakeholders. Focus group discussions will elicit the opinion of men living with HIV, including those who are participating in CARGs and those who are not. Women living with HIV who are participating in CARGs were also engaged in focus group discussions.

The Big Picture

This study is designed to inform efforts to enhance the coverage, quality, and impact of HIV services by optimizing differentiated service delivery for men. The study team has worked closely with MOHCC and other local stakeholders to ensure a high degree of local engagement and the potential for uptake of study findings in health systems strengthening and CARG implementation.

The study is now complete and analysis is ongoing. Preliminary results were presented by MOHCC at CQUIN’s Annual Meeting in February, 2018.

View the AIDS 2018 Abstract

For more information on the study, contact Miriam Rabkin at

Learn about ICAP’s broader portfolio of work in Zimbabwe.