Abstract:
In sub-Saharan Africa, hospitalized patients with HIV, most of whom present with
advanced stage disease, have poor post-admission linkage and retention rates in outpa-
tient HIV care. Limited success in transitioning between inpatient and outpatient care is
likely due to lack of education, psychosocial issues, and lack of integration between
inpatient and outpatient care structures.
• Trained patients, known as peer navigators, have been shown in the literature to
improve adherence and address psychosocial barriers to care for HIV-infected patients
and provide one solution to address issues in transitioning during care. An inpatient
HIV peer navigator program was implemented at Moi Teaching and Referral Hospital,
the second largest referral hospital in Kenya.
• Four HIV peers were hired, with 2 peers largely managing the inpatient setting with
occasional support from 2 outpatient HIV peers. Through implementation of this pro-
gram, we have been able to provide disease state, adherence, and disclosure counseling;
provide antiretroviral refills; facilitate liaison between inpatient and outpatient care to
improve acute care management; and provide outpatient follow-up to more than 1,000
patients since 2014.
• After overcoming staff reservations about introducing a new healthcare cadre in the
inpatient setting, the program gained acceptance within the medical teams and hospital
staff. Current challenges include high patient volumes and lack of privacy on the inpa-
tient wards. A prospective evaluation of our peer navigator program is underway.