Transcript International Center for AIDS Care and Treatment Programs

Ambassadors for
Adherence: Provision of
Highly Effective Defaulter
Tracing by Peer Educators in
Tanzania
Mihayo M Bupamba, R. Mbatia, M.
Strachan, G. Nkobelerwa, S. Spendi, A.
Mkamballah, A E Cunningham
ICAP-Columbia University, Tanzania
Background
• Worldwide, Columbia University’s International Center
for AIDS Care & Treatment Programs (ICAP)
supports comprehensive HIV prevention, care, and
treatment services at more than 1200 health facilities
in 15 countries.
• In Tanzania, ICAP collaborates with the Ministry of
Health and local government authorities to support
127 HIV care and treatment centers (CTC) in 3
mainland regions and Zanzibar.
• Current Ministry policy links home based care (HBC)
programs into defaulter tracing of HIV clients. But
coverage of HBC activities is not universal and many
CTC clients are not enrolled in HBC programs.
PE Program Overview (1)
• Since 2008, people living with HIV/AIDS (PLHIV) have
been engaged to assist clients attending CTCs and
support retention and adherence in CTC and PMTCT
settings.
• By June 2010, a total of 389 PLHIV work in 74 CTCs
and PMTCT Clinics as peer educators (PE).
• One of the core tasks of ICAP PEs is to follow-up
defaulting clients in their homes to document their
vital status, and to encourage them to return to care.
PE Program Overview (2)
• PEs were selected using standardized criteria
including: adherence to HIV care/treatment, physical
capability, demonstrated interpersonal skills,
willingness and commitment
• District/Community involvement and sensitization
• PE trained on HIV basic education, behavioural risk
reduction, drug side effects, adherence &
psychosocial support, conducting peer-support groups
• Provided with working tools, monthly stipend and
ongoing supervision and support
Roles and Responsibilities of PEs
•
•
•
•
•
Work at both CTCs and PMTCT sites
Provide group and individual counselling
Facilitate internal and external referrals
Support linkages to community services
Conduct defaulter tracing for ART clients who miss
appointments and/or are lost to follow-up (LTFU)
(three consecutive missed appointments)
• Receive lists of clients from clinic staff and call or visit
clients at home and provide feedback to facility
Methodology
• PEs effect on defaulter tracing was assessed
over 18 months (Oct 08 - Mar 10) at 41 CTCs
with nearly 10,000 active clients on ART from
Kagera, Kigoma, Pwani and Zanzibar.
• An additional 34 new sites have just received
training in the last quarter and are not included
in this analysis.
• 84% of all CTCs with active defaulter tracing
programs reported their findings.
Distribution of ICAP Sites
and PE activities as of June 2010
Region
Kagera
Kigoma
Pwani
Zanzibar
TOTAL
# of
CTCs
57
27
35
8
127
# of CTCs
# of sites
with peer reporting on
educators
defaulter
tracing
19
13
27
15
22
10
6
3
74
41
Results (1)
• 3,949 clients were
reported to have either
missed appointments or
LTFU
• PEs either reached
personally or confirmed
vital status for 2,720 (69%)
of listed clients
• Of the clients traced by
PEs, 411 (10%) had died
and 2,309 (59%) were still
alive
Regional Variations in PE Defaulter Tracing Outcomes
(Oct 08 - Mar 10)
100%
86%
90%
3949
80%
70%
64%
59%
60% 57%
46% 43%
50%
40%
31%
31%
25%
30%
18%
20%
12%
10%
8%
6%
10%
4%
0%
Kagera
Kigoma
Pwani
Zanzibar
TOTAL
% found alive
% died
4500
4000
3500
3000
2500
2000
1500
1000
500
0
% not found
# missed appointment or LTFU
Reasons for defaulting among clients
who gave one or more reasons when
located by PEs (Oct 09 - Mar 10)
alternative
treatment
13%
transfer /
changed
address
35%
drug side
effects
8%
distance /
transport
44%
Conclusion
• Trained and supervised PEs in the 3 regions plus
Zanzibar have demonstrated high effectiveness in
tracing patients lost to follow-up.
• PEs are highly valued by the CTC and PMTCT
clinic staff for their support to clients, retention and
clinic operations.
• Next steps in defaulter tracing include focusing on
pre-ART patients, PMTCT mothers, and linking PE
tracing activities to patient records to accurately
measure ‘return to clinical care’ outcomes.
Acknowledgements
Asante Sana!