Community involvement approach strengthens antiretroviral retention rates in Inhambane: Recommendations for best practices

Issues: Antiretroviral therapy (ART) became available in Mozambique in 2005. With increased access to ART, high rates of loss to follow-up (LTFU) are threatening program outcomes. According to the Ministry of Health's national data, the LTFU rate was 15% in 2009 and 18% by December 2010.

Description: In partnership with the International Center for AIDS Care and Treatment Programs Mozambique, Pathfinder International has been implementing a community involvement approach to addressing LTFU since February 2009. The program trains people living with HIV (PLHIV) volunteers as peer educators (PEs) to conduct home visits to defaulters and other vulnerable patients, and implement community sensitization activities to promote an enabling environment for ART adherence and retention. All PEs work with the support of community leaders (CLs) and community-based organizations (CBOs), receiving regular training updates, including HIV/ART/Tuberculosis, positive prevention, adherence, and community mobilization.

Lessons learned: Program data show as much as a 5% drop in global LTFU rates since implementing the PLHIV–PE approach. One health facility in Inhambane showed a decrease in overall LTFU from 25% in June 2009 to 20% by December 2010. Integration of PLHIV as PEs into existing CBO and CL programming increased the program's retention rate.

Recommendations: Programs challenged by high LTFU rates may benefit from this integrated PLHIV–PE program strategy. The authors recommend replicating this effective approach in other HIV care and treatment facilities.