Horizons Projects | Community Education and Referral: Supporting Adherence to Antiretroviral Treatment and Prevention for People with HIV in Zambia

HORIZONS PROJECT
Community Education and Referral: Supporting Adherence to Antiretroviral Treatment and Prevention for People with HIV in Zambia

Recognizing the vital importance of preparing and involving communities in antiretroviral (ARV) treatment programs, Zambia’s Ministry of Health, the International HIV/AIDS Alliance, and national NGOs came together to implement a community preparedness and referral intervention (the ACER project). The Institute of Economic and Social Research at the University of Zambia and the Horizons program were commissioned to evaluate the project.

The study was carried out in Lusaka and Ndola, Zambia. Research partners included the International HIV/AIDS Alliance, University Teaching Hospital (Lusaka), Ndola Central Hospital, the Institute of Economic and Social Research at the University of Zambia, the Archdiocese of Lusaka, the Catholic Diocese of Ndola, Kara Counselling, the Network of Zambian People Living with HIV/AIDS, and the Traditional Health Practitioners' Association of Zambia.

Formative research for this study was conducted in November 2002, which clearly demonstrated that communities want to be involved in prevention as well as in supporting safe and effective delivery and use of ARV treatment.

Based on this research, an intervention was implemented that focused on community education and referral for supporting adherence to ARV treatment and prevention for people with HIV. The intervention was evaluated by an experimental, randomized, comparative pre- and post-intervention design that tested the effectiveness of the community education and referral package to strengthen health literacy, particularly about ARVs; achieve better health-seeking behavior; improve equity of access to care; boost ARV adherence; and increase the practice of preventive behaviors among people with HIV.

Key findings include:

There was a significant increase among people on antiretroviral therapy (ART) in Lusaka who cited peer groups as a source of information.
HIV knowledge increased over time but there was little difference between the intervention and comparison sites.
HIV testing significantly increased in the Ndola intervention site over the study period.
Partner disclosure among people on ART remained about the same in the study sites.
Mean 4-day self-reported adherence was very high in all sites, but decreased over longer periods of recall.
There were positive changes in knowledge of partner’s status among people on ART in the Lusaka intervention site.
There were significant reductions in internalized stigma among people on ART in Lusaka.
Community stigma decreased over the study period in both the intervention and comparison sites; however, it remained a problem.
Most referrals by community partners were for voluntary counseling and testing followed by ART.

Based on these initial findings and experiences, a scaled-up version of this community engagement approach commenced in Uganda in February 2007 and is already extended across seven districts, with 83 openly-positive network support agents, who combine the functions of the ACER treatment support workers and treatment mobilizers to work three days a week in ART clinics and the rest of the time in the community. Within Zambia plans are also developing for a similar extension of the approach to other urban and rural settings in 2008.

Location

Ndola, Lusaka, and Kabala, Zambia

Duration

May 2004–June 2007

Horizons and Population Council researchers

Avina Sarna, Eka Esu-Williams, Scott Geibel, Naomi Rutenberg

Non-Council collaborators

Mandeep Dhaliwal, Sam McPherson (International HIV/AIDS Alliance)

V. Mtonga (Central Board of Health, Government of Zambia)

Phillimon Ndubani (Institute of Economic and Social Research, University of Zambia)

Fiona Samuels (Overseas Development Institute)

Africa Directions

Alliance Zambia

Archdiocese of Lusaka

Catholic Diocese of Ndola

FAPCAS

Kara Counselling

Mwengu Social and Health Research Center

Ndola Central Hospital

Network of Zambian People Living with HIV/AIDS

Traditional Health Practitioners' Association of Zambia

University Teaching Hospital (Lusaka)

Donors

US Agency for International Development

European Union

Publications/Resources
Horizons and Population Council researchers' names appear in boldface type.

2008
Samuels, Fiona, Joseph Simbaya, Avina Sarna, Scott Geibel, Phillimon Ndubani, and Jolly Kamwanga. “Engaging communities in supporting HIV prevention and adherence to antiretroviral therapy in Zambia,” Horizons Research Summary. Washington, DC: Population Council. (PDF)

2006
Samuels, Fiona, J. Simbaya, Phillimon Ndubani, Avina Sarna, and Scott Geibel. "Preparing communities for increased availability of antiretroviral therapy: Initial findings from Zambia," Horizons Research Update. Washington, DC: Population Council. (PDF)

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