“We were able to save ourselves and help others.” A Community-Based Approach to ART Adherence in Ethiopia

By Tibebe Shenie, Country Director, NASTAD Ethiopia; Anne Sites, Senior Manager, Global Program, NASTAD; Alan Lifson, University of Minnesota and NASTAD Consultant

Produced by Ben Lifson, Lead Editor; Deborah Dillaway, Videography; Alan Lifson, Producer

Map of Ethiopia

Ethiopia

Arba Minch is a rural town in the foothills of the Rift Valley in the Southern Nations, Nationalities, and Peoples’ Region (SNNPR) of Ethiopia. In addition to the town, many people live in the surrounding villages, supporting themselves through farming and fishing. In SNNPR, the prevalence of HIV among adults is estimated at 1.5%. The Ethiopian government has made a strong commitment to provision of life-saving antiretroviral therapy (ART), with 249,174 adults and 16,000 children receiving ART as of 2012. However, among those enrolling in HIV care, approximately 25% were no longer retained in care after one year.

Ethiopian regional health bureaus asked NASTAD Ethiopia to support them in designing effective community based interventions to help prevent this loss to care. NASTAD Ethiopia collaborated with the School of Public Health at the University of Minnesota to conduct a baseline assessment, which revealed a number of barriers and challenges for HIV patients in accessing medical care, including lack of money for transportation, great distances between patients and health facilities, and stigma associated with the disease. Based on these results, plus involvement of a number of key stakeholders including local, regional and national health bureaus, HIV clinicians, and community organizations (including associations of people with AIDS), an intervention was developed.

The target population for this intervention was 142 HIV-positive adults who were newly enrolled in care at one of the HIV Clinics in the Arba Minch area. Thirteen community support workers (most of whom were also living with HIV) provided: education on HIV treatment and healthy living; counseling and social support (including helping clients to address feelings of internalized stigma, and barriers to adherence and retention in care); and referrals to other community organizations for food or other assistance. Each support worker was given a cell phone to call a designated HIV Clinic nurse for questions about new medical symptoms or changes in clinical status.
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The intervention was found to be highly successful, with very little loss to follow-up.  Both the patients and the community support workers who participated in the program benefited greatly from the sense of mutual support, openness and positivity that this community oriented intervention provided.

You can watch a short video of the participants’ moving testimonies below.

If you are interested in learning more about how NASTAD is supporting people living with HIV through a variety of programs and interventions in Ethiopia, please contact Anne Sites.

Visit NASTAD.org/global to learn more about the NASTAD Global Program.

Anna Carroll, Senior Associate, Global Program, NASTAD, also contributed to the development of this post.

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