Leveraging peer-based support to facilitate HIV care in Kenya

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.