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Peer mentors capacity building approach to improve adherence and retention in HIV care and treatment: The ARIFU project experience. Dr. Judith Kose – Otieno EGPAF Kenya Technical Director/ Op ARIFU lead March 2013

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Dr. Judith Kose – Otieno EGPAF Kenya Technical Director/ Op ARIFU lead March 2013

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Dr judith kose otieno egpaf kenya technical director op arifu lead march 2013

Peer mentors capacity building approach to improve adherence and retention in HIV care and treatment: The ARIFU project experience

Dr. Judith Kose – Otieno

EGPAF Kenya Technical Director/ Op ARIFU lead

March 2013

Co- Authors: Lucy Wambugu1; Gacheri Muthuuri1; Anthony Kamau1; Irene Mukui 2; Titus Syengo1

Affiliations: 1. Elizabeth Glaser Pediatric AIDS Foundation 2. Ministry of Health


Background

Background

  • EGPAF-Kenya has implemented the Operation ARIFU Project, a CDC-funded project working with Aids Control Units (ACU) of Non-Military Uniformed Services (NMUS) since 2008.

  • The project aims to improve HIV care and treatment services in 34 health facilities serving 121,000 uniformed services personnel and their families.

  • Adherence to HIV treatment is critical to reduction of HIV-related morbidity and mortality, however, national retention is 69%, with adherence at 12 months of 70%.

  • Barriers to adherence: poor counseling, weak mechanisms to follow clients, and limited client knowledge of ART benefits.

  • Strategies to improve adherence: use of HIV clinic diaries to help track patients, good adherence counseling support, targeted treatment literacy sessions and defaulter tracing.


Methodology

Methodology

  • ARIFU adopted the peers in workforce approach to address adherence barriers at 16 supported ARIFU sites countrywide.

  • In October 2011, 20 HIV-positive mothers (mentor mothers) from 16 supported sites were identified and trained by EGPAF on: adherence counseling; ART defaulter tracing using clinic diaries; treatment literacy; community PMTCT and community prevention with positives interventions.

  • Mentor Mothers received onsite quarterly mentorship by program staff and monthly stipends of US$ 50 upon report submission.

  • Duties included adherence preparation and counseling, ART defaulter identification using clinic diaries, tracing of defaulters via phone calls and home visits and offering treatment literacy sessions to HIV-positive clients.


Mother m entors reports

Mother Mentors Reports


Reasons for not sending reports

Reasons for not sending reports

  • Reports not signed by facility manager

  • Mother mentor was unwell and missed some days

  • Mother mentor dies (n=1)

  • Mother mentor got a job elsewhere (n=2)

  • Reports lost in the courier system (later resent)


Results

Results


Results c ontinued

Results Continued

  • By September 2012, ARV retention at these 16 supported sites improved from 36% to 85%;

  • 90% of clients received three counseling sessions, provided by mother mentors - under guidance of facility staff, before treatment initiation, per national standards; and

  • 88% of identified defaulters were traced and returned to treatment.


Hiv care and treatment data

HIV Care and Treatment Data


Mother mentors w orkshop

Mother Mentors Workshop


Facility in charges meeting

Facility in charges meeting


Conclusions

Conclusions

  • Use of peer mentors was associated with improved adherence and retention in HIV treatmentat supported sites.


Acknowledgements

Acknowledgements

  • The mother mentors


Thank you

THANK YOU


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