Peer navigators impact HIV care

Agnes Thwesha uses her experiences to help others

The South African government currently has the largest HIV antiretroviral treatment (ART) program in the world. This multisector response includes decentralized ART distribution from primary health clinics and expanded ART eligibility. Despite the notable progress, more than 100,000 AIDS-related deaths are recorded annually, 40% of individuals diagnosed with HIV are not linked to care, and there were an estimated 270,000 new HIV infections in 2016.

To address these challenges, the Centers for Disease Control and Prevention in South Africa partnered with I-TECH in 2016 to evaluate the efficacy of two interventions, peer navigation (PN) and SMS, as part of the Engagement to Care study. The study was conducted by I-TECH, University of California, San Francisco, and the North West Department of Health was aimed at enhancing engagement to HIV care, including improving overall preventive behaviors, retention in HIV care, and adherence to medication.

Eligible participants included patients accessing HIV testing or care in a study clinic, recently diagnosed with HIV, aged 18 years or older, and with access to a cellular telephone where they are willing to receive automated SMS with HIV-related messaging. The study provided PN services to over 280 newly diagnosed HIV patients in seven primary health care (PHC) clinics in Bojanala Platinum District, North West Province. Peer navigators, HIV-positive individuals who have demonstrated commitment to adhering to medication, worked with clients to assess barriers to engagement in care and treatment, adherence, and prevention, and also helped them to overcome these barriers.

Findings showed that both SMS and PN interventions significantly shortened the time needed to link to care. The effects were particularly pronounced for the PN intervention where the odds of people in SMS clinics and PN clinics linking within 30 days were 1.6 and 2.8 times higher respectively. Findings also showed that patients in the PN services have 62% retention, with 1.8 times the odds of being retained in care at 12 months as compared to standard of care (SOC) participants. Peer navigation more consistently kept clients in care compared to SOC, with trends for preART clients and significant results for ART clients, explained Jessica Grignon, Director of Programs at I-TECH South Africa.

Grignon said: “The impact of peer navigation was most evident around helping patients overcome stigma-related barriers, in order to disclose, elicit social support, and make prevention decisions. There were also great outcomes around retention. We saw really pronounced outcomes around linkage for men, which were 4.6 times higher than men in standard of care.”

However, Grignon cautioned that peer navigation is not a silver bullet and, “doesn’t work for everyone.”

“Peer navigators have to assess the situation to determine what works for each client. What we saw in the study was that if a peer navigator spent up to three hours a month with a client, the retention and linkage outcomes were favorable. But, if they spent more time (more than three hours a month) the outcomes were poor. Investigators believe that clients who required more time were not candidates for peer navigation,” she said.

Using her experiences to help others

Agnes Thwesha (48) has been living with HIV for 20 years. Living with the virus has taught her what she describes as life’s biggest lesson, “To accept what you can change and find ways to manage it.”

Thwesha, who is also a traditional healer and a PN, acknowledges that accepting that you are HIV-positive is not an easy feat, but she says, “the load becomes lighter is someone is carrying it with you.” That is the mindset she brings when visiting her clients who are newly diagnosed with HIV.

“I have been there, I know how it feels when you are told you are HIV-positive. You first think the nurse made a mistake. Questions start going through your mind, ‘how will I tell my partner, will he blame me for infecting him and what will happen to children’.”

This is where PNs like Thwesha play a vital role. They use their own experiences to encourage clients and to offer emotional support to clients during the disclosure process. They continue walking with them on their treatment journey until they are confident that they are able to walk on their own. If a client defaults along the way, Thwesha and her peers follow up with them to ensure they are linked back into care.