Improved ART adherence through case managment in Ethiopia

Background: The Ethiopia HIV/AIDS Care and Support Program (HCSP) supports comprehensive HIV/AIDS services through ART services in 350 health centers (HC) to 75,000 clients, from a target population of 500,000 HIV infected Ethiopians. The HCSP provides case managers (CM) to each ART HC. The majority of CMs are HIV-infected and act as “expert patients.” They receive initial 21 day training before being placed in community HC within their home area. Annual 5-day refresher trainings are provided. CMs support a care plan for each HIV-infected client, with an emphasis on HIV treatment adherence, and ensure effective follow-up within the community. Methodology: To determine the effectiveness of the CM approach, we conducted a qualitative study on the outcomes of the approach through focus group discussions with ART providers, HIV positive clients, and community volunteers. Results/Outcome: Our results indicate that CMs have been effective in quality of care, improved ART uptake and adherence, and a lost-to-follow-up rate of only 7% (national rate is 23%). A key factor is empathy and commitment to ART clients, which fosters mutual trust, a shared HIV-positive status, and experience with managing medication side effects. Conclusion: ART adherence and access to comprehensive services are improved and the lost to follow-up rate decreased significantly by the use of CM. This success is due to the empathetic nature of the CM and a shared HIV status. Mentoring and support of the health center staff, and linkages with the community are essential for success of the CM approach. .