FHI - FHI/Zambia Documents Benefits of Adherence Support Workers in Care and Treatment Programs

JUNE 2008—HIV/AIDS is a major threat to Zambians, with an estimated 1.2 million people infected nationwide. Increased access to antiretroviral therapy (ART) is helping reduce death rates from HIV/AIDS, but the lack of qualified staff to ensure the treatment regimen is carefully followed is a serious obstacle. New research carried out by FHI and Zambian Ministry of Health suggests that training community volunteers as adherence support workers is relatively low cost, achieves high-quality results, and may help bridge the human resources gap.

Why adherence is important

Drug adherence is key to success of ART. It is desirable that patients achieve 100 percent adherence to keep the correct amount of drugs in their bodies to fight the virus. This means taking the right drugs in the right doses at the right times and frequencies, and attending all scheduled clinical visits and procedures. A critical aspect of adherence is the patient's own decision to take the drugs—and adhere to them for life. Nonadherence is the patient's inability to take the drugs or attend clinical visits in the prescribed manner. Nonadherence can lead to treatment failure, rise in viral load, and development of drug-resistant forms of HIV.

The FHI research

In Zambia, as in many countries that are rapidly scaling up ART services, the need for adherence counseling is particularly dire as a result of shortages of trained healthcare workers. While the World Health Organization and Zambian Ministry of Health recommend staff to population ratios of 1:5,000 and 1:700 for doctors and nurses, respectively, in Zambia these ratios are 1:17,589 and 1:8,064. To combat these shortages and strengthen adherence counseling, the Zambia Prevention, Care and Treatment Partnership (ZPCT) developed an innovative strategy of training community volunteers to provide adherence support at the health facility and community levels.

The research (read it here, PDF 162KB)—the first of its kind in Zambia—measured the effectiveness of shifting adherence counseling tasks from healthcare workers to community volunteers, called adherence support workers (ASWs) at five selected ART sites in four provinces. The ASWs, who worked alongside doctors and nurses and were supervised by a professional healthcare worker, conducted community visits to track down patients who had missed their clinic appointments and provided educational and psychosocial support, referrals, and other support to improve adherence.

The study, led by FHI/Zambia Director of Technical Support Kwasi Torpey, used quantitative and qualitative research techniques to determine that use of volunteer ASWs did not compromise the quality of counseling, and that, with qualified supervision, ASWs could help relieve the human resources shortage at Zambian health facilities. The findings also suggested that using ASWs helped reduce waiting times and loss to follow-up rates of new clients (that is, those who can no longer be located) from 15 percent to 0 percent. The authors suggested that ASWs, who are mostly living with HIV/AIDS themselves, may even be in a better position than healthcare workers to provide empathic and emotional support as well as needed community follow-up.

About ZPCT

Funded by the US President's Emergency Plan for AIDS Relief through USAID, the Zambia Prevention, Care and Treatment (ZPCT) Partnership is a six-year collaboration between the Republic of Zambia and the United States to strengthen and expand HIV and AIDS services in five provinces. For more information, view this brochure about ZPCT.

FHI Adherence Support Worker Training (two-week intensive training course)

UNAIDS/Zambia Country Report

PHOTOS: Loveness Mwanga Ntalasha (pictured on home page) was among the graduates of a 2006 adherence support worker training course in in Mansa, Luapula Province, Zambia (top).

—James Francis McNulty