As the morning sun hits Pala Village in Ndhiwa, Homa Bay County, Fauzia (not her real name) makes her way into Pala Level Four Hospital.
Fauzia who is HIV positive is here, not just to pick her Anti-Retroviral medication, but also pick seven other doses for her seven neighbours.
“They are my support group colleagues, so once I pick the drugs from the hospital on their behalf, they come to my house to pick them,” said Janet.
Two years ago, Janet and her colleagues transformed their support group into Community ART Group (CAG) after Homa Bay county adopted this initiative borrowed from other African countries.
According to Kenya AIDS Strategic Framework II 2020/21-2024/25 Mid Term Review Report, Homa Bay County is leading in HIV prevalence at 15.2 per cent.
Community ART Group (CAG) is an innovative initiative by Homa Bay which aims to reduce hospital visits for dispensing anti-retroviral medication.
Instead, those in the anti-retroviral treatment can come together and have one of them pick drugs from hospital on their behalf.
Fauzia adds: “We alternate. Today I am picking the drugs on behalf of all the members, another member of the group will come next month to pick on behalf of all of us.”
CAG tested and proven
In 2014, the county conducted a benchmarking sessions in South Africa and Zimbabwe to learn how the countries were dealing with defaulting cases of anti-retroviral treatment.
Justus Ochola, Head of Research, Innovation and New Learning Unit was part of the delegation for the benchmarking.
“Despite various interventions, HIV viral suppression remained a big challenge in the county, and this means ART defaulting rates were high,” said Ochola.
In 2018, the county began to pilot the CAG following its approval by the National Syndemic Diseases Control Council (NSDCC).
And when the pilot presented positive results, the county scaled up the initiative, and eventually enrolled all the health facilities in Homa Bay County by 2022.
In the initiative, People Living With HIV come together in groups of between five and 30, and register with a health facility as a CAG.
The health facility then prepares a register which it uses to monitor the beneficiaries and dispense the drugs.
“When someone is discontinued, their names are removed from the register,” said Ochola.
One can be discontinued from the register when they die, develop HIV-related diseases such as Tuberculosis, or when pregnant.
“There could also be issues of group dynamics, such as misunderstanding and disagreements which would create disharmony in the group,” Ochola added.
Once a member gets to the facility, the officer incharge of dispensing the drugs verifies with the register before issuing the drugs.
The person collecting the drugs is issued with a register which he or she ticks once the group members collects their drugs.
The drugs which are not issued for any reason are returned when picking the next batch.
Clifford Omondi, the Medical Superintendent at Pala Level Four Hospital says this initiative has helped reduce workload for the understaffed facility as there are nolonger long queues during clinic days.
He says the facility serves 53 CAG groups with memberships of between five and 10 people.
He noted that the clusters have made it easier to monitor the beneficiaries as the CAG group members know each other and are able to report to the facility should there be any challenges with drug adherence or any other critical issue which requires intervention by the facility.
“This initiative has recorded positive results to us and our clients. We have greatly reduced missed appointments, hence increased suppression rates,” said Omondi.
At Ndhiwa Sub County Hospital, the situation is the same.
According to Hospital Superintendent Benard Otieno, already seven groups have been enrolled into the program which is showing remarkable progress in management of HIV.
“This is one of the best practices with so much to envy. On a clinic day, we can see less than 20 people representing over 70 people,” he said.
He notes that the initiative has also helped deal with stigma as members of the groups now easily share their experiences in managing the condition.
“Once we do viral load tests, and they show positive progress, they are able to share within their groups and encourage others who are not doing as well to embrace positive practices which can help them cope with the treatment,” he said.
Saida (not her real name) collects her medication from Ndhiwa Sub County Hospital. She is a member of one of the groups enrolled into the program at the facility.
“Previously I would come to the hospital every clinic day top collect my drugs. But today, I only come when there is need as we alternate with other group members to come and collect the drugs,” she said.
This, she says has saved her the transport money she would spend to get to the facility. It has also saved her time as she is able to engage in other income generating activities as opposed to days when she would personally collect her drugs.
According to Mr Ochola, the initiative is one of the best interventions in managing viral suppression, as the county is already enjoying its fruits.
Mr Ochola says, since the start of the program, the county has seen improved cases of viral suppression from 43 per cent in 2022, to 68 per cent in 2023, 78 per cent in 2024, and 87 per cent as at May 2025 among the adult population.
“When the rate of viral suppression is high, it means adherence to anti-retroviral treatment is high, and we look forward to having the rates go even higher,” he said.
Mr Ochola however notes that the initiative has been slow to pick up in areas where homesteads and sparsely distributed as people find it difficult to access neighbours.
One such place is Unga village in Ndhiwa.
When Lake Region Bulletin visited the place, Mr Ochola was engaging people living with HIV from the area on the benefits of embracing the idea.
“Once you come together, you will notice the benefits from this program,” Ochola told them during a sitting at Unga Chief Camp.
He assured them that the beneficiaries of the project can still visit hospitals for personal appointments and for other ailments.
He added: “This initiative does not mean that you nolonger go to hospital. It only reduces the burden of hours spent in hospital during clinic days, as well as money you spend on transport for your frequent visits. It also gives you an opportunity to open up and share freely about issues challenges and wins in the management of HIV.”
Some of the attendees however claimed that apart from the sparse distribution of homesteads, stigma remains one of the biggest hurdles to embracing the initiative.
“Even here where we are, some of us have chosen to register for drug collection in facilities far away from here due to stigma. Some even go to Ndhiwa Sub County Hospital, Homa Bay County Referral Hospital just to make sure people here do not discover that they are HIV positive,” said Fatma (not her real name).
Ochola noted that the county has put in place a number of interventions which have been working together towards scaling down new HIV infections in the county, as well as
As at May 2025, records from the county health department showed that 128, 000 people in the county are living with HIV, with almost the entire population on ARV treatment.
Ochola said the youths have been cagey at embracing the idea, hence another hurdle in the intervention to manage the viral load.
According to Ochola, as at May 2025, viral suppression among the youths between the ages of 15 and 24 stood at 76 per cent, as compared to adults which is 87 per cent.
“We have other interventions targeting the youth, such as use of youth champions, but we continue to engage them to take up this noble initiative,” he said.
As more interventions come up, Fauzia, Jane and her colleagues are hopeful that they will beat the fear of the impacts of HIV, and extend their life expectancy so as to allow them care for their children.
