Overcoming Barriers to HIV Care: Findings from a Peer-Delivered, Community-Based, Linkage Case Management Program (CommLink), Eswatini, 2015–2018

MacKellar, Duncan; Williams, Daniel B.; Dlamini, Makhosazana; Byrd, Johnita; Dube, Lenhle; Mndzebele, Phumzile; Mazibuko, Sikhathele; Pathmanathan, Ishani; Tilahun, Endale; Ryan, Caroline

doi:10.1007/s10461-020-02991-2

Cited by 12 publications

(36 citation statements)

References 28 publications

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“…Providing recommended linkage services such as peer-delivered, linkage case management, escort, and treatment navigation may be particularly important for many ICT-diagnosed PLHIV who were not seeking care when tested and may not have been prepared to enroll early in HIV care on their own following diagnosis [ 1 – 3 , 17 – 25 ]. Beginning at the point of diagnosis, CommLink peer counselors used their personal experiences living with HIV to help clients overcome real and perceived barriers to care by providing psychosocial and informational support, testifying about how they overcame their own barriers to care, correcting misperceptions about HIV and ART, and staying with their clients during at least the first clinic visit to ensure they were comfortable and knowledgeable about receiving care at their referral facility.…”

Section: Discussionmentioning

confidence: 99%

“…CommLink methods have been described previously [ 24 , 25 ]. Briefly, CommLink was implemented by Population Services International (PSI) in Hhohho, Manzini, and Lubombo regions of Eswatini in two phases: Phase I, June 2015 –March 2017, and Phase II, April 2017 –March 2018.…”

Section: Methodsmentioning

confidence: 99%

“…In Phase I, CommLink was implemented by two outreach HTS teams, each operating with a modified van with two rooms (mobile unit) in rural and urban Tinkhundla (similar to districts) in Hhohho and Manzini regions [ 24 ]. In Phase II, CommLink expanded to four mobile-unit teams and provided HTS and linkage services in three of the four regions of Eswatini [ 25 ]. In both phases, each team included two or three HTS counselors, three or four HIV-positive expert-client (peer) counselors, and a nurse.…”

Section: Methodsmentioning

confidence: 99%

“…Clients who were not eligible to receive case management were provided standard referrals in accordance with national guidelines [ 26 ]. Linkage case management during both phases included peer-delivered counseling and psychosocial support, escort and treatment navigation at healthcare facilities, weekly telephone calls, and at least two follow-up face-to-face counseling sessions focused on disclosure and ICT, and identifying and resolving barriers to HIV care [ 24 , 25 ]. CommLink peer counselors were HIV-positive, ART-adherence counselors trained and certified by the Eswatini Ministry of Health.…”

Section: Methodsmentioning

confidence: 99%

“…Peer counselors strived to appoint and meet their clients at healthcare facilities within 7 days of diagnosis. As part of treatment navigation, they met and stayed with their client for the duration of at least their first facility visit, provided psychosocial and informational support, and ensured that they understood the stations and sequence of HIV care [ 24 , 25 ]. Participating clients were provided case management through enrollment in HIV care and at least the first antiretroviral refill if initiated on ART for up to 90 days [ 24 , 25 ].…”

Section: Methodsmentioning

confidence: 99%

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HIV testing and ART initiation among partners, family members, and high-risk associates of index clients participating in the CommLink linkage case management program, Eswatini, 2016–2018

et al. 2021

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To help diagnose and initiate antiretroviral therapy (ART) for ≥95% of all persons living with HIV (PLHIV), the World Health Organization (WHO) recommends offering HIV testing to biological children, and sexual and needle-sharing partners of all PLHIV (index-client testing, ICT). Many index clients, however, do not identify or have contactable partners, and often substantially fewer than 95% of HIV-positive partners initiate ART soon after index testing. To help improve early HIV diagnosis and ART initiation in Eswatini (formerly Swaziland), we implemented a community-based HIV testing and peer-delivered, linkage case management program (CommLink) that provided ICT as part of a comprehensive package of WHO recommended linkage services. CommLink was implemented June 2015 –March 2017 (Phase I), and April 2017 –September 2018 (Phase II). In addition to biological children and partners, HIV testing was offered to adult family members (Phases I and II) and high-risk associates including friends and acquaintances (Phase II) of CommLink index clients. Compared with Phase I, in Phase II proportionally more CommLink clients disclosed their HIV-infection status to a partner or family member [94% (562/598) vs. 75% (486/652)], and had ≥1 partners, family members, or high-risk associates (contacts) tested through CommLink [41% (245/598) vs. 18% (117/652)]. Of 537 contacts tested, 253 (47%) were HIV-positive and not currently in HIV care, including 17% (17/100) of family members aged <15 years, 42% (78/187) of non-partner family members aged ≥15 years, 60% (73/121) of sexual partners, and 66% (85/129) of high-risk associates. Among 210 HIV-positive contacts aged ≥15 years who participated in CommLink, nearly all received recommended linkage services including treatment navigation (95%), weekly telephone follow-up (93%), and ≥3 counseling sessions (94%); peer counselors resolved 76% (306/404) of identified barriers to care (e.g., perceived wellness); and 200 (95%) initiated ART at a healthcare facility, of whom 196 (98%) received at least one antiretroviral refill before case-management services ended. To help countries achieve ≥90% ART coverage among all PLHIV, expanding ICT for adult family members and high-risk associates of index clients, and providing peer-delivered linkage case management for all identified PLHIV, should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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HIV testing and ART initiation among partners, family members, and high-risk associates of index clients participating in the CommLink linkage case management program, Eswatini, 2016–2018

et al. 2021

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Implementing a male‐specific ART counselling curriculum: a quality assessment with healthcare workers in Malawi

Robson,

Mphande,

Lee

et al. 2024

J Int AIDS Soc.

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IntroductionThere is little HIV counselling that directly meets the needs of men in Eastern and Southern Africa, limiting men's knowledge about the benefits of HIV treatment and how to overcome barriers to engagement, contributing to poorer HIV‐related outcomes than women. Male‐specific approaches are needed to improve men's outcomes but may be difficult for healthcare workers (HCWs) to implement with fidelity and quality in low‐resource settings. We developed a male‐specific counselling curriculum which was implemented by male HCWs and then conducted a mixed‐methods quality assessment.MethodsWe audio‐recorded counselling sessions to assess the quality of implementation (n = 50) by male HCWs from two cadres (nurse, n = 10 and lay cadre, n = 10) and conducted focus group discussions (FGDs) with HCWs at 6 and 9 months after rollout to understand barriers and facilitators to implementation. Counselling sessions and FGDs were translated, transcribed and analysed using thematic analysis adapted from WHO Quality Counselling Guidelines. We assessed if sessions were respectful, informative, interactive, motivating and included tailored action plans for overcoming barriers to care. All data were collected September 2021−June 2022.ResultsAll sessions used respectful, non‐judgemental language. Sessions were highly interactive with most HCWs frequently asking open‐ended questions (n = 46, 92%) and often incorporating motivational explanations of how antiretroviral therapy contributes to life goals (n = 42, 84%). Few sessions included individually tailored action plans for clients to overcome barriers to care (n = 9, 18%). New counselling themes were well covered; however, occasionally themes of self‐compassion and safe sex were not covered during sessions (n = 16 and n = 11). HCWs believed that having male HCWs conduct counselling, ongoing professional development and keeping detailed counselling notes facilitated quality implementation. Perceived barriers included curriculum length and client hesitancy to participate in action plan development. Findings were similar across cadres.ConclusionsImplementing high‐quality male‐specific counselling using male nurses and/or lay cadre is feasible. Efforts to utilize lay cadres should be prioritized, particularly in low‐resource settings. Programmes should provide comprehensive job aids to support HCWs. Ongoing training and professional development are needed to (1) improve HCWs’ skills in tailored action plans, and (2) sensitize HCWs to the need for self‐compassion within male clients to promote holistic sexual health.

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Peer Approaches to Improve HIV Care Cascade Outcomes: a Scoping Review Focused on Peer Behavioral Mechanisms

et al. 2022

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Overcoming Barriers to HIV Care: Findings from a Peer-Delivered, Community-Based, Linkage Case Management Program (CommLink), Eswatini, 2015–2018

Cited by 12 publications

References 28 publications

HIV testing and ART initiation among partners, family members, and high-risk associates of index clients participating in the CommLink linkage case management program, Eswatini, 2016–2018

HIV testing and ART initiation among partners, family members, and high-risk associates of index clients participating in the CommLink linkage case management program, Eswatini, 2016–2018

Implementing a male‐specific ART counselling curriculum: a quality assessment with healthcare workers in Malawi

Peer Approaches to Improve HIV Care Cascade Outcomes: a Scoping Review Focused on Peer Behavioral Mechanisms

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