Lay Counselors: a Critical Link between Care Centers and Community

FEBRUARY 2009 — In the Rift Valley's Eldama Ravine Hospital, FHI-supported volunteer lay counselors serve a critical function in the comprehensive care center (CCC) that provides clinical services and ART: they link the CCC to the community and to the health facility.

Based at the CCC, the lay counselors help HIV-positive women overcome their reluctance to move directly from the antenatal clinic (ANC) to the CCC, as that may identify their HIV status. Because of the shortage of nurses in Kenya, PLHIV under APHIA II have volunteered to become lay counselors. Because they are sensitive to the needs and feelings of others who are HIV-positive, they can help with the "escorted referral," a function that until recently was undertaken by a nurse. Nurses can now use their cell phones to notify the lay counselor that there is a patient to escort to the CCC. The counselor welcomes the patient and makes her feel at home. She becomes a "buddy," and helps the woman go from the ANC to the CCC for initial clinical screening.

In addition to linking the ANC to the CCC, the lay counselor also connects to the woman's community and home, providing ongoing treatment adherence and psychosocial support, and ensuring regular follow-up at the ANC and CCC.

The outcome of the intervention has been a decreased loss to follow up, increased adherence to ART, and increased likelihood of delivery at the health facility rather than at home. According to Dr. John Adungosi, FHI Kenya Director for Care and Treatment "mobilizing PLHIV to fight HIV transmission works in the Rift Valley and other parts of Kenya. It is the way to go in fulfillment of the WHO strategy to involve PLHIV in fighting the epidemic."

PHOTO: Jane Anyango, a volunteer counselor, checks on a Comprehensive Care Center client. (Jim Daniels)