THE ROLE OF PLHIV IN COMMUNITY ART SERVICE DELIVERY DR. STEPHEN WATITI (MB. CH.B)

INTRODUCTION Limited human resource in form of doctors and other trained cadres in the face of very high numbers of PLHIV in need of care calls for innovations like use of PLHIV in ART service delivery (90%- 90%-90%). Involving PLHIV in ART programmes is in line with the GIPA/MIPA principle & it helps them to learn important lessons for themselves from the trained health service providers. In the face of reduced funding from donors and yet people needing ART are increasing following the new WHO guidelines, use of PLHIV will help us do more with less money. Involving PLHIV in ART should be part of task shifting for stable clients to decongesting facilities & pay more for attention to sick or unstable patients by clinicians and nurses. PLHIV living within communities can be very effective in outreaches and at drug distributions points.

OPPORTUNITIES PLHIV are readily available human resource to support limited staffing in health care. They can do follow up & adherence counseling in communities. Help reduce in patient waiting time and promote retention in care since HIV care is chronic care. Support in pre-packing of drugs and participate in other non or less technical services. Can eligibly refill peers’ on ARVs & Co-trimoxazole/Dapsone PLHIV can be serve as peer counselors and expert patients. PLHIV are credible treatment supporters who can draw from personal experience to help others.

OPPORTUNITIES (CONT’D) Very instrumental in educating the community to demystify HIV & AIDS Reduction in cost of health service delivery Can make community based care effective for stable patients & hence decongest health facilities Support reduction of stigma in society if well handled & whole communities sensitized Promote Positive Health Dignity and prevention, (PHDP) among peers Refer appropriately community members for services related to HIV Knowledge hub for community members about HIV

LESSONS Involvement of PLHIV more cost effective especially in resource limited countries with few health workers Helps with effecting & comprehensive task shifting There is need for regular training because experiential learning needs to be supported; especially in the face of the ever changing guidelines. Utilization of PLHIV certainly reduces costs and ensure sustainability Training materials like ART data collection tools need to be simplified and translated into languages PLHIV understand well. The involvement PLHIV in drug distribution, establishes a social safety net among peers and improves adherence.

CHALLENGES HIV & AIDS treatment illiteracy and difficulties of explaining complex concepts related to HIV in simple & understandable terms can be a limiting factor. Low literacy levels of patients leading to need to translate materials in local languages. Wide spread stigma: need for role models- doctors, nurses, community leaders and etc.

WAY FORWARD Treatment literacy training should be part of the ART services: people can not give what they don’t have! Plan & budget for motivation and compensation of PLHIV who volunteer to support peers Scaling up integration HIV services in general health care Sensitise whole communities to reduce stigma and discrimination Other HIV and AIDS care facilities need to consider adopting the TASO model for improved efficiency and effectiveness.