An evaluation of using community-based peer navigators for improving HIV treatment outcomes among antiretroviral therapy clients in Malawi Defence Force clinics.

Abstract

BackgroundMalawi Defence Force (MDF) implemented test-and-start strategy in 2016 to expedite initiation of antiretroviral therapy (ART) for HIV diagnosed individuals. However, key indicators for the 95-95-95 targets, namely retention and viral load suppression, remained sub optimal. To address this, MDF introduced community-based peer navigators (PNs) in 2020 to support ART adherence. We sought to assess impact of this intervention.MethodsA mixed methods study was conducted where ART programmatic data was collected retrospectively from seven MDF health facilities. The analysis compared treatment interruption (ITT), return to treatment (RTT) and viral suppression rates 18 months before and after the intervention.ResultsThe median numbers IIT and RTT was 308 (IQR = 96) and 99 (IQR = 67) pre intervention respectively, while the median IIT and RTT was 145 (IQR = 47) and 160 (IQR = 46) post intervention respectively. Treatment current increased by 36.5% through back to care (BTC) and by 10.4% through new initiations. Out of 1,073 clients due for VL flagged on patient cards, 953 (88.9%) had their blood samples taken compared to 61.8% in pre intervention period (p < 0.01).ConclusionsThe involvement of PNs led to notable improvements in program outcomes. Expanding the peer navigator model within the BTC initiative is recommended to sustain and build upon these gains.