Chikuni community-based approach to decrease lost to follow-up
C. Caraciolo1, P. Himpyali2, A. Banda1, E. Lungu1, C. Endyke-Doran3
1Chikuni Mission Hospital, AIDS Relief, Monze, Zambia, 2C.A.R.E Barbados, AIDS Relief, Monze, Zambia, 3University of Maryland, School of Medicine, Institute of Human Virology, Lusaka, Zambia
Issues: Chikuni is a mission hospital in rural Zambia, with HIV prevalence of 18% and a catchment area of 25,000. The hospital initiated the ART program, with support from PEPFAR through the AIDSRelief program, in November 2005 and has consistently maintained unusually low loss to follow-up (LTFU) rates. The success is due in-part to a strong community program. Since adherence to ARVs has been well documented to be the link to long term viral suppression, the hospital emphasizes strong links with the community to reinforce adherence. In October 2008, it was observed that LTFU was beginning to rise. In December 2008 the hospital quickly reinforced community linkages to address adherence.
Description: strategies used:
Supportive groups: Support groups, accompanied by counsellors, were formed in 21 outreach centers and HIV awareness sensitizations were conducted in schools and villages.
Media: Chikuni hosts a community radio station with HIV programmes to encourage adherence and fight discrimination and stigma.
Outreach programmes: Continued visits to outreach centers were conducted to review patient files and reinforce adherence counseling.
Leaders: Sensitization meetings with leaders, such as village headmen, school heads, teachers/lecturers, priests, and the Chief.
[Percentage of LTFU at Chikuni Mission Hospital]
Lessons learned: Chikuni was able to mobilize the community through pre-existing linkages to reverse the trend of increasing LTFU. While the LTFU has stabilized at 0.6%, the percentage remains very low.
Next steps: The measures put in place facilitated the reduction in lost to follow - up and hence increase in drug adherence These emphasis on strong community linkages will continue.
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