Evaluation of Using Community Based Peer Navigators for Improving HIV Treatment Outcomes Among Antiretroviral Therapy Clients in Malawi Defense Force
Abstract
Introduction: Malawi Defence Force (MDF) implemented test-and-start strategy in 2016 to expedite initiation of antiretroviral therapy (ART) for individuals diagnosed with HIV. Despite these efforts, key indicators for the 95-95 95 targets, such as retention in care and viral load suppression rates, remained below optimal levels. To address this, MDF introduced community-based peer navigators in 2020 to support ART adherence. This study aimed to assess the impact of this intervention.
Methods: A mixed methods study was conducted where programmatic data was collected retrospectively from 7 sites to compare treatment interruption (ITT), return to treatment (RTT) levels and viral load indicators 18 months before and after introduction of community-based peer navigators.
Results: The median IIT and RTT was 308(IQR =96) and 99(IQR=67) in pre-intervention period respectively while in post intervention, the median IIT and RTT was 145(IQR=47) and 160(IQR=46) respectively. Treatment current (TX_CURR) rate increased by 36.5% through back to care (B2C) 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 only 61. 8% in pre-intervention period (p < 0.01).
Discussion: The involvement of peer navigators led to notable enhancements in program outcomes, particularly in re-engaging clients and improving viral load monitoring. Expanding the peer navigator model within the BTC initia tive is recommended to sustain and build upon these gains.
