1. Don’t Get Lost: How Peer Navigation Can Link HIV-Positive Key Populations to Care and Treatment and Reengage Those Lost to Follow-Up
Tiffany Lillie,1 Steave Nemande,1 Honorat Gbais,2 Stephany Kersten,2 Daniel Levitt,1, 2 Flavien Ndonko2
LINKAGES
CARE/CHAMP

2. Background: Linking HIV-Positive Key Populations (KPs) to ART
HIV Prevalence: FSWs, 36.9% (nationally); MSM, 44.3% (Yaoundé), and 24.2% (Douala)
Most KPs diagnosed HIV positive not linked to care or ARV treatment:
High stigma experienced by KPs (pushes them to be very mobile, and to provide wrong contact number/address)
Denial
Long procedures to initiate treatment
Wide gap between the number of people put on treatment as compared to the number of positive cases
Even for those already on treatment, an increase in cases of dropping out
No active mechanism to track client flow within the community and at health facility levels

3. Solution: Peer Navigation
Peer navigation (PN) system initiated to support enrollment and retention of HIV-positive KPs in the HIV service cascade, as well as adherence to treatment.
Peer navigators are HIV-positive, medication-adherent role models who understand and can convey clearly how to access and utilize key services for people living with HIV and their partners, loved ones, and children.

4. Methods
USAID- and PEPFAR-funded LINKAGES and CHAMP projects piloted the PN system in Yaoundé, Cameroon
Two community-based organizations (CBOs) (FSW and MSM) engaged
24 potential candidates selected, then participated in 1-week training followed by 1-month practical internship within the CBO
After internship, 21 retained and given contracts after a performance assessment
Programmatic data: November 2015-July 2016 (pre-PN) compared to August-December 2016 (after PN initiation)

5. Results
838 HIV-positive FSWs and 557 HIV-positive MSM accessed services from the 2 CBOs
Preliminary data showed increases in client linkage to care and treatment
About 39% of newly diagnosed HIV-positive clients linked before PN vs. as high as 82% after PN introduced
38% of MSM and 71% of FSWs living with HIV who were lost to follow-up before PN recovered in just 4 months of PN implementation, then linked to treatment

6. Results (continued)

7. Testimony from a Peer Navigator
“Being a peer navigator brings me a lot of joy and satisfaction because I not only follow current patients, but also help older patients who have abandoned treatment.”
“We encourage them to come back for treatment and health services. We follow them so that they avoid some churches that are pushing them to abandon treatment for prayer only. We tell them that they should not for any reason stop treatment.”
“We really are helping save lives, a lot of lives. We become like family members because through our role we really help reduce the number of deaths in the community. I am grateful that I was trained as a peer navigator to support others living with HIV”
(Marceline, PN, 38 years old)

8. Peer Navigators from Horizons Femmes

9. Conclusions
An increase was observed in the proportion of KPs on ART with peer navigation
The likelihood of putting KPs on ART was about twice as high with PN than without it
This approach appears promising for KP-related HIV programming efforts to reach the 2nd 90 of the UNAIDS goal of by 2020.

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11. Acknowledgments