Community Education and Referral: Supporting Adherence to Antiretroviral Treatment and Prevention for People with HIV in Zambia
This study sought to improve health-seeking behavior, equity of access to HIV services, adherence to ARV treatment, and prevention for people with HIV through a community preparedness strategy emphasizing community education and referral, and significant involvement of people with HIV and other stakeholders in the community.
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 findings and experiences, a scaled-up version of this community engagement approach commenced in Uganda in February 2007 and was 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 have also been made to develop a similar extension of the approach to other urban and rural settings.
Engaging communities in supporting HIV prevention and adherence to antiretroviral therapy in Zambia (PDF)
Samuels,Fiona; Simbaya,Joseph; Sarna,Avina; Geibel,Scott; Ndubani,Phillimon; Kamwanga,Jolly
Horizons Research Summary
Publication date: 2008
Project Stats
Location: Zambia (Kabala, Lusaka, Ndola)
Program(s):
HIV and AIDS
Topic(s):
Behavior change
HIV care, support, and treatment
HIV prevention
Duration: 5/2004 - 6/2007
Population Council researchers:
Scott Geibel
Naomi Rutenberg
Avina Sarna
Non-Council collaborators:
Africa Directions
Alliance Zambia
Archdiocese of Lusaka
Catholic Diocese of Ndola
FAPCAS
Fiona Samuels (International HIV/AIDS Alliance)
Kara Counselling
Mandeep Dhaliwal (International HIV/AIDS Alliance)
Mwengu Social and Health Research Center
Ndola Central Hospital
Network of Zambian People Living with HIV/AIDS
Pillimon Ndubani (Institute of Economic and Social Research, University of Zambia)
Sam McPherson (International HIV/AIDS Alliance)
University Teaching Hospital (Lusaka)
V. Mtonga (Central Board of Health, Government of Zambia)
Donors:
European Union
US Agency for International Development
Get Involved
- Make a contribution to the Population Council
- Honor a loved one with a gift in their name
- Sign up to receive e-mail announcements
Connect
