Table 2 Key insights and BIGPIC prototype features

Strength: Community, sense of brotherhood

Group-based care model to provide peer support and education

Locally-based CHWs facilitate group formation

Community-based health screening to ensure local group formation

Strength: Community leadership

Participants elect group leaders and are self-governed by a mutually agreed upon constitution.

Barrier: High cost of care (medications, transport, cost of services, caregiver burden)

Group care is combined with a microfinance program to increase individual access to funds for personal or medical use.

Clinician brings basic medication supply box at every visit

Community-based health screening to ensure local group formation.

Rural clinician and CHWs travel to group meetings at local community centers.

Barrier: Far distance to health facilities and poor quality roads

Community-based groups are linked with a local CHW.

Community-based health screening to ensure local group formation.

Rural clinician and CHWs travel to group meetings at local community centers.

Barrier: Poor quality of existing physician-patient relationships

Same physicians return to the group as much as possible.

Clinicians trained in group care are existing CDM clinicians.

Concern: Variable group dynamics, particularly between age groups and gender

Participants create and sign a mutually agreed upon constitution that emphasizes self-governance and conflict resolution.

Groups have a minimum number of study participants, and participants can bring additional friends/family to join the group until the maximum group size is attained.

Concern: Stigma associated with illness or with AMPATH’s reputation as an organization for people with HIV.

Increased efforts for community education and destigmatization.

Remove AMPATH logo from trucks.

Concern: Confidentiality

Group constitution includes a confidentiality clause that is created by the group members.

Time is allotted for individual clinician assessment at every group care meeting.

Concern: High cost of participation (share value) may prohibit some from joining

Group members agree upon share value at the start of the group.

Limited number of shares can be bought per meeting.

Concern: Sustainability of new programs

No external funding/seed money is required to start a microfinance group.

Clinicians trained in group care are existing CDM employees.

Early local and governmental leadership involvement.

Implementation occurs with existing CDM teams.