Contributions of the lay workers in providing home-based treatment adherence support to patients with advanced HIV/AIDS disease in low-income settings: Lessons learned from the field in Tanzania and Zambia

  • Godfather Dickson Kimaro National Institute for Medical Research, Muhimbil Medical Research Centre, Dar es Salaam
  • Christian Bottomley Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
  • Amos Kahwa National Institute for Medical Research, Muhimbil Medical Research Centre, Dar es Salaam
  • Lorna Guinness Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
  • Sokoine Kivuyo National Institute for Medical Research, Muhimbil Medical Research Centre, Dar es Salaam
  • Victoria Simms Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
  • Bernard Ngowi National Institute for Medical Research, Muhimbili Medical Research Centre, Tanzania
  • Duncan Chanda Institute for Medical Research and Training, University Teaching Hospital, Lusaka, Zambia
  • Shabbar Jaffar Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
  • Godfrey S. Mfinanga Sayoki Mfinanga National Institute for Medical Research, Muhimbil Medical Research Centre, Dar es Salaam
Keywords: Lay workers, home visits, advanced HIV disease

Abstract

Introduction: In 2018, there were appropriately 20.6 million [18.2 million–23.2 million] people living with HIV in Eastern and Southern Africa, and an estimated 67% of them were on antiretroviral therapy (ART). A major challenge in the scale-up of ART services in Sub-Saharan Africa is the severe shortage of clinical staff.

Methods: We conducted a randomised trial in Tanzania and Zambia to test an innovative intervention that involved the use of lay health workers and screening for cryptococcal meningitis and tuberculosis. Here we describe the model of care with a particular focus on the trained lay worker component. Lay workers carried out home visits to patients in the intervention arm to deliver antiretroviral drugs, provide adherence counselling, and conduct simple monitoring for treatment side effects and other medical conditions. Lay workers were responsible for referring patients with conditions that might require further medical attention as well as discouraging self-referral. A total of 1999 participants were enrolled in the trial. Lay workers were recruited through public advertisements.

Results: Six lay workers were recruited in each country and trained for two weeks. Each lay worker was paid a monthly salary of US$ 487.61 in Zambia and US$ 524.61in Tanzania. They were also paid communication and transport expenses for home visits. The median number of visits per patient was 3 for Tanzania and 4 for Zambia. On average a lay worker was responsible for 72.3 patients in Tanzania and 94.5 in Zambia for 1 year. Referrals were made in 9% of the home visits and self-referral was discouraged in 64% of visits.

Conclusion: The use of paid lay workers to provide HIV/AIDS services in urban settings where there is a shortage of clinical staff may help to identify ART related side effects/adverse reactions and prevent unnecessary referrals. 

Published
2020-09-04
How to Cite
KimaroG. D., BottomleyC., KahwaA., GuinnessL., KivuyoS., SimmsV., NgowiB., ChandaD., JaffarS., & MfinangaG. S. M. S. (2020). Contributions of the lay workers in providing home-based treatment adherence support to patients with advanced HIV/AIDS disease in low-income settings: Lessons learned from the field in Tanzania and Zambia. Tanzania Journal of Health Research, 21(2), 1-10. https://doi.org/10.4314/thrb.v21i2.
Section
Articles

Journal Identifiers


eISSN: 1821-9241
print ISSN: 1821-6404