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1 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 Wambugu 1 ; Gacheri Muthuuri 1 ; Anthony Kamau 1 ; Irene Mukui 2 ; Titus Syengo 1 Affiliations: 1. Elizabeth Glaser Pediatric AIDS Foundation 2. Ministry of Health Slide 2 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. Slide 3 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. Slide 4 Mother Mentors Reports Slide 5 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) Slide 6 Results Number of clients per quarter IndicatorDec 11Mar 12Jun 12Sept 12Total Adherence preparation counseling 144 202299 265 910 Assisted disclosure 53 90116 279 538 Pregnant women linked to care 24 5617 82 179 HIV-exposed infants linked to care 22 4523 89 179 Community to facility referrals 56 396 83 238 Facility to community referrals 55 6570 42 232 Missed HIV care appointments 23 3349 93 198 Clients traced 15 2133 76 145 Returnees to treatment 7 1425 53 99 Slide 7 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. Slide 8 HIV Care and Treatment Data Indicator20112012 Reporting ART sites1117 Cumulative enrolled on HIV care (men and women) 9021234 Current on CTX328 (36%)998 (81%) Newly enrolled on ARV94191 Cumulative on ARV179370 Current on ARV71 (36%)314 (85%) Slide 9 Mother Mentors Workshop Slide 10 Facility in charges meeting Slide 11 Conclusions Use of peer mentors was associated with improved adherence and retention in HIV treatment at supported sites. Slide 12 Acknowledgements The mother mentors Slide 13 THANK YOU