Increasing HIV/AIDS Therapy Adherence among Youth in Mozambique: The TAP/Pathfinder International Experience

This overview of the World Bank-funded Treatment Acceleration Project in Mozambique outlines Pathfinder's comprehensive programme for youth that integrates counselling, treatment, and care to promote HIV testing and antiretroviral therapy (ART) adherence for HIV-positive youth. The report highlights the positive role peer educators (PEs) played in improving adherence to antiretroviral drugs in Mozambique by HIV-positive youth. According to the report, the project's use of HIV-positive PEs helped improved treatment adherence among young patients through PEs' provision of counselling, role modeling, and home visits. The involvement of PEs also led health providers to recognise the value of patient-friendly services.

The report points out that a positive HIV diagnosis can be overwhelming for youth who are highly sensitive to peer values and who may also be poorly equipped to handle such a personal crisis alone. Following from this, the project adapted a previous Pathfinder training manual, "Community Home-Based Care for People and Communities Affected by HIV/AIDS," to train PEs in areas including counselling, home visits, and outreach. According to the report, PEs integrated these counselling skills with role modelling to lead by example - reinforced through the sharing of their experiences that HIV is not a death sentence. The report argues that this, coupled with a conveyed sense of optimism, reinforced the importance of treatment adherence to patients and helped contribute to annual adherence levels as high as 100% in some cases.

The report also notes the importance of PE home visits. With permission, PEs accompanied their clients home on the first day of diagnoses. In this way, PEs were able to provide support, verify patient addresses, assess the availability of food and clean water, and gauge whether or not patients could expect emotional support from family members. PEs were also able to support patients who disclosed their status, follow up with those who missed appointments, and alert healthcare providers in the event that home-bound patients needed serious medical attention. PEs became resources for patients and families alike and were able to relay concerns from those affected to healthcare providers who were able to better tailor their services.

The report concludes by advocating that PEs - especially those who are HIV-positive - be included in future programming. It also recommends that programming allow these educators to have an increased level of responsibility and latitude in planning and implementing their community outreach activities, allowing programmes to become better tailored to local contexts. Researchers also recommend that PEs be used to conduct home visits in order to strengthen the commitment of both client and educator to treatment adherence and to offer affected families an additional source of information and support. While the study showed initial evidence that PEs may be able to relay important information to healthcare providers and help these providers improve service delivery, researchers also contend that more can be done within programmes to harness this potential.