The pillar of ROM’s community programming
Each HIV-positive client is attached to a peer community health worker, who usually lives in their community and is also HIV-positive. The community health workers monitor adherence to treatment and ensure retention in care. They are the link between the health facility and the home, closely following up with clients who have poor adherence and linking them to adherence support groups. The clnically unwell, clients with social issues, the newly diagnosed with TB, and those with detectable viral loads are also followed up closely by the CHW. Clients out-of-reach for home visits are followed up through phone calls.
The peer community health workers include community antiretroviral and tuberculosis treatment supporters (CATTS), teenage and adolescent supporters (TAS), mother-to-mother (M2M) supporters, and the most-at-risk populations peers. At ROM’s site in Kasaala, the Village Health teams (VHTs) and the expert clients conduct the community follow-ups.
In 2015, the major socio-economic challenges identified were alcohol abuse, food insecurity, non-disclosure and domestic violence. The home visits have resulted in marked improvement to retention in care, adherence to medications, prevention of mother-to-child transmission, and TB treatment outcomes.
With the most-at-risk (MARPs) populations, a peer-to-peer approach and MARPs networks were used to increase access to services for MARPs. These peers helped ensure that they were retained in care, and those with clinical or social challenges were supported and referred accordingly. The MARPs were mainly followed up through phone calls to remind them of clinic appointments and offer counseling when necessary. In 2015, the MARPs retention in care was 92%.