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

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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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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.
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 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.
conclusions
Conclusions
  • Use of peer mentors was associated with improved adherence and retention in HIV treatmentat supported sites.
acknowledgements
Acknowledgements
  • The mother mentors
ad